Retirement of a Member: Lord Smith of Clifton
 - Announcement

Lord Fowler: My Lords, I should like to notify the House of the retirement, with effect from today, of the noble Lord, Lord Smith of Clifton, pursuant to Section 1 of the House of Lords Reform Act 2014. On behalf of the House, I should like to thank the noble Lord for his very valued service to the House.

Lord Speaker: Powers
 - Question

Lord Grocott: To ask the Leader of the House what plans she has to make proposals for a review of the powers of the Lord Speaker.

Baroness Evans of Bowes Park: My Lords, this is a matter for the House to decide. Of course, it is open to any noble Lord to bring forward a proposal to the Procedure Committee. Although I do not intend to do it myself, I understand that a proposal for a review is likely to be tabled for the next meeting. As a member of the Procedure Committee, I will of course consider any proposal.

Lord Grocott: I am grateful, in part, for that. When the Leader considers that, she might reflect on a couple of things, one of which is that this must surely be the only legislative Assembly anywhere in the world where at Question Time the only person not allowed to speak is the Speaker. That must be a first by anyone’s standards. I simply say to her that, to anyone watching from the Public Gallery or elsewhere, the proceedings in this House at Question Time are often a complete shambles. They are a shouting match and unintelligible to a neutral observer. It is now nearly two years since we debated this matter in the House and I ask the Leader to ensure—as far as it is within her power to do so—that we have a debate on and reach a decision about the Lord Speaker’s power, perhaps in time for an experiment to start at the beginning of the next Session.

Baroness Evans of Bowes Park: As I said to the noble Lord, my understanding is that a proposal will be coming before the Procedure Committee. I have not seen it, so I am afraid that I cannot comment further. However, I am sure that, following a discussion on it, the Senior Deputy Speaker will update the House.

Baroness D'Souza: My Lords, I of course welcome the suggestion by the noble Lord, Lord Grocott, that there should be what was originally intended to be a five-year review of the Lord Speaker’s powers in this House, but I point out and emphasise that the House has always operated on the basis of self-regulation. That is an extremely valuable convention simply because it ensures that each and every Peer in this House takes responsibility for the courtesies of the House. I understand that these have become somewhat frayed of late, but to undermine self-regulation would be an unfortunate precedent.

Baroness Evans of Bowes Park: I agree with the noble Baroness. I believe that self-regulation works and characterises this House. It means that we do not need to resort, for instance, to selection of amendments and force groupings, programme Motions or guillotines, none of which, I think, would noble Lords want to be introduced to the House.

Lord Newby: Does the noble Baroness the Leader of the House agree with me that this modest proposal from the noble Lord, Lord Grocott, which would give the Speaker some powers to moderate the way we deal with Questions, does not necessarily imply a wholesale change in the role of the Lord Speaker? This is simply a straightforward, stand-alone reform that is long overdue.

Baroness Evans of Bowes Park: The noble Lord is of course a member of the Procedure Committee so he will no doubt make his views heard when a discussion is had.

Baroness Bloomfield of Hinton Waldrist: My Lords, I agree with the noble Baroness, Lady D’Souza, that we should be able to show courtesy to each other at Question Time. More often than not this is the case, but can my noble friend the Leader enlighten the House about how often she or her Front-Bench colleagues have to intervene to assist the House at Question Time?

Baroness Evans of Bowes Park: Since July 2018 we have had 76 sitting days with Oral Questions and the Front Bench has had to intervene only 13 times.

Baroness Hayman: My Lords, is it not correct that, when the role of Lord Speaker was originally set up, a review after the term of office of the first Lord Speaker was envisaged? That review never took place. Is it not timely to look at the role of the Lord Speaker, in its entirety but including Question Time? While I hesitate to disagree with my successor, the noble Baroness the Leader of the House has just described how the Front Bench can assist self-regulation at Question Time. For many people—although we know that the Leader of the House is completely impartial—having a member of the Government assist the House in deciding who should speak does not feel good in a parliamentary democracy. That role could be undertaken by the Lord Speaker without undermining the principle of self-regulation.

Baroness Evans of Bowes Park: The noble Baroness will be aware that aspects of the Lord Speaker’s role were considered by a group on working practices, chaired by my noble friend Lord Goodlad, which produced a report in 2011. In subsequent years, the House took various decisions on its proposals, including deciding not to change the role of the Lord Speaker at Question Time. As I said in my original Answer to the noble Lord, Lord Grocott, I believe a discussion will be had in the Procedure Committee. If any recommendations are made, it will be for the House to decide whether it wishes to support them.

Baroness Hayter of Kentish Town: The important thing is that this is done; it is not good for it to fester. The word “timely” was just used, and this is a point we should consider. I would like to make a minor correction. If I understood the Leader of the House correctly, she said that the Chief Whip or somebody else had to intervene 13 times—I think that means from the Dispatch Box. The number of hands pushing and indicating is way above that. We have to recognise that this happens far more often than the figure of 13 perhaps suggests.

Baroness Evans of Bowes Park: The noble Baroness is right: that is interventions from the Dispatch Box. Generally, though, as we have said, I believe that Question Time works, that noble Lords show respect and courtesy towards one another, and that self-regulation is an important characteristic of this House.

Lord Haselhurst: My Lords, appreciating that I might put myself at some risk, having served in your Lordships’ House for no more than seven months, I suggest to the Leader that we would get much more out of Question Time if it were conducted by the Lord Speaker, who would maintain equity between party and non-party groups and perhaps other disciplines as well.

Baroness Evans of Bowes Park: I assure my noble friend that the Chief Whip and I do everything we can to ensure fairness around the House in answering Questions. In fact, almost 85% of tabled Questions asked since July did not come from the government Benches. We try to ensure as Question Time goes on that all Members of the House are given the opportunity to speak and to ask questions, which is an extremely important part of scrutiny of the Government.

Lord Howarth of Newport: My Lords—

Lord Dubs: My Lords, how does the Leader of the House choose between us?

Baroness Evans of Bowes Park: I think noble Lords have just shown that they can do it for themselves.

Lord Howarth of Newport: My Lords, does the noble Baroness the Leader of the House recall Walter Bagehot’s distinction between the dignified parts and the efficient parts of the constitution, and his observation that the dignified parts were imposing, old and venerable?  Does she agree with me that the Lord Speaker on the Woolsack should remain dignified—not to mention imposing, old and venerable—and should not become efficient because, as the previous Lord Speaker has said, it is crucial to the effectiveness of this Second Chamber that we preserve our culture and practice of self-regulation?

Baroness Evans of Bowes Park: I entirely agree with the noble Lord.

Female Offender Strategy
 - Question

Bishop of Gloucester: To ask Her Majesty’s Government what progress they have made in implementing the female offenders’ strategy.

Lord Keen of Elie: My Lords, the Female Offender Strategy, published in June 2018, outlines the Government’s long-term vision for improving outcomes for female offenders in custody and in the community. The strategy sets out a programme of work that contains a number of commitments that will take some years to implement. A new women’s policy framework was published last December, and my noble friend Lord Farmer’s review of family ties for female offenders is expected to report in the coming weeks.

Bishop of Gloucester: My Lords, I welcome that information from the Minister, which follows many positive commitments to the female offender strategy. However, we are still awaiting news of residential pilots, action to strengthen links between probation services and women’s centres, the report from the noble Lord, Lord Farmer, and a national concordat. Given that many of the strategy’s commitments have no clear timescales—indeed, in some cases the suggested deadline has already passed—how does the Minister plan to effectively monitor progress and stay on track?

Lord Keen of Elie: My Lords, we are concerned to ensure that these recommendations are implemented as soon as practicable; indeed, the women’s policy framework was implemented as of 21 December 2018. We are taking forward further work in partnership with other groups and parties. I note the work of the Nelson Trust, which I know the right reverend Prelate is directly involved in, which recently put in a bid for additional funding from the ministry to further its community work. We are encouraged by the strength of that and similar bids, and want to take that forward as soon as possible.

Lord Blunkett: My Lords, if my noble friend Lady Corston were here, she would be enthusiastically supporting the right reverend Prelate in pressing for the review to be implemented as quickly as possible, not just on moral grounds but because the additional investment that the Minister has referred to is “spend  to save”. We could save an enormous amount of money by diverting into prevention and early intervention, rather than having women prisoners in the kind of conditions that I saw when I was Home Secretary.

Lord Keen of Elie: My Lords, I entirely concur with the noble Lord’s observations. Indeed, our Female Offender Strategy seeks to build on the seminal report of the noble Baroness, Lady Corston, which of course goes back to 2007.

Baroness Burt of Solihull: My Lords, the extension of mandatory post-custody supervision has disproportionately affected women. Recall numbers for men have risen by 22% since the changes were introduced but for women they have grown by 131%. Women are trapped in the justice system rather than being enabled to rebuild their lives. The Prison Reform Trust has called for mandatory post-custody supervision to be abolished. Does the Minister agree that the present system is not working, and does he have plans to review it?

Lord Keen of Elie: My Lords, the idea of mandatory supervision for those serving a sentence of less than 12 months was introduced only quite recently. There is a disproportion between male and female offenders in that context—I quite accept that. Indeed, that manifests itself in various other parts of the prison and custodial system. At the moment, we are seeking to extend community centre services, to help to accommodate those released after short sentences, and to combine community services with treatment requirement protocols.
That is extremely important, particularly for female offenders, where we see a vast proportion who have reported elements of mental health difficulty or who suffer from alcohol issues and, very often, drug abuse issues as well. Over and above that, an enormous proportion of these female offenders have at times been subject to domestic violence. We are trying to direct these services at these issues and will continue to do so.

Lord Selkirk of Douglas: Does my noble friend accept that in recent years there have been a considerable number of pregnant women in prisons? Can he assure us that in every case the person concerned will be treated with sensitivity?

Lord Keen of Elie: This is a very important issue for us. In all cases where a female offender is in custody, we endeavour to ensure that birth does not take place within the prison system, but sometimes that cannot be avoided. We have extensive services for mothers and children up to the age of 18 months when it is necessary for them to be in custody—I emphasise the word “necessary”. When an offender is reaching the end of a short sentence, steps are taken to try to ensure that mother and child are kept together. However, of course this cannot be done in circumstances where there has been a serious offence that results in a mother being in custody for a lengthy period.

Lord Beecham: The right reverend Prelate referred to the strategy envisaging greater use of residential and community services instead of custodial sentences.  To what extent is that occurring? Are the Government still adhering to their policy of limiting funding of the strategy to £5 million over two years, replacing their previous plan to spend £50 million on five new prisons? If so, what is happening to the other £45 million?

Lord Keen of Elie: My Lords, there is an important shift in policy away from custody as a means of trying to resolve these issues. That is why we moved away from the proposal for five community prisons; we hope they will not be required. Instead, we have shifted the balance in the direction of community services. We will pilot such community residential services in five areas to see how they work. For that purpose, we have committed funding of up to £5 million over the next two years, but of course that will not be the end of the matter. We will address the consequences of the pilot in these five areas and see how we can take things forward from there.

Lord Reid of Cardowan: Does the Minister recall that 15 years ago, during my noble friend Lord Blunkett’s custodianship of the Home Office, the Sentencing Guidelines Council approved indeterminate sentences for more serious crimes, on condition that there should be a significant reduction at the lower end for less serious crimes, particularly for women and women with debt? Unfortunately, from the judiciary’s point of view, that has never been fully implemented. May I congratulate the Government on moving away from custodial sentences and ask them to look to this long-standing recommendation that has never been fully implemented?

Lord Keen of Elie: I agree with the force of the noble Lord’s point. In fact, Section 152 of the Criminal Justice Act 2003 clearly requires the courts to consider imposing non-custodial sentences unless otherwise justified. The Sentencing Council guidelines from 2016 reinforce this move. In addition to that, we have a judgment from the criminal Court of Appeal in the case of Petherick in 2012, which set out the criteria for sentencing in cases involving, for example, a female offender with dependent children. We have been moving in the right direction, but I accept that we have not moved far enough and we are determined to see if we can do that.

Digital Mapping: Restrictions
 - Question

Lord Fox: To ask Her Majesty’s Government whether they place restrictions on commercial companies seeking to digitally map towns and cities in the United Kingdom; and if not, why not.

Lord Young of Cookham: My Lords, there are no restrictions on the creation of mapping databases of the UK. The UK has world-leading mapping data and this is an area of competitive advantage, offering  significant economic opportunities. In 2018, the Government created the Geospatial Commission to elevate this strength and it is currently developing a UK-wide strategy to realise the opportunities. As part of this, it will consider both risks and opportunities for current arrangements for access to mapping data.

Lord Fox: I thank the Minister for his Answer. This is privately gathered data. There is at least one major high-definition survey going on, financed by a foreign-owned company that bases its services on Russian mapping software. Every day, data is processed in places such as Nairobi. This is not Google Maps; it is high-definition software pinpointing our civil infra- structure. The Minister seems relatively unconcerned about this. Can he assure your Lordships’ House that a risk analysis will be carried out on the security nature of this data and some sort of strategy provided around how it is controlled within the obviously important commercial interests going on in this country?

Lord Young of Cookham: I understand the noble Lord’s concern. He has tabled a number of Written Questions on the subject. In view of his concern, I have gone back to those responsible for security and received an assurance that those responsible for our critical national infrastructure are not asking for the restrictions on commercial mapping that the noble Lord seeks.

Lord West of Spithead: My Lords, precision digital mapping and the metadata associated with it are crucial in establishing nodal analysis and targeting, nodal analysis being identifying the one or two spots within water, energy and transport systems that, when taken out, can bring a nation to its knees. Bearing that in mind, could the Minister let us know exactly who is looking at this to make this decision? It is pretty critical and, as a nation, we went to immense efforts to discover people who might be our enemies so that we could do them harm. We do not want to open ourselves up to people to do us harm.

Lord Young of Cookham: Again, I understand the noble Lord’s concern. Access to critical national infrastructure sites is, of course, heavily restricted. Ordnance Survey, as the Government’s national mapping agency, is the only mapping organisation that has right of access to property for the purpose of mapping under the Ordnance Survey Act, passed by your Lordships’ House in 1841. But in view of the concern that the noble Lord has expressed and that of the noble Lord, Lord Fox, I will go back to double-check the information I have been given. Of course, much of this information is already obtainable through satellites and Google street survey. The Soviet Union mapped the UK since the 1940s. One has to be realistic about the amount of information already available—satellites can identify objects that are 30 centimetres long.

Lord Dubs: My Lords, would the Minister care to comment on the following? I was returning in a taxi from outside London to London. Going up my road,  the driver was able to tell me the colour of my front door—he knew exactly what it was. Is that a healthy situation to be in?

Lord Young of Cookham: I hope it enabled the noble Lord to reach his destination. The geophysical data available helps people in their everyday lives. Noble Lords waiting for a 159 bus can use their iPhones to see when that bus will be coming. Noble Lords who might have forgotten where they parked their car can use their mobile phones to identify it. Noble Lords who go jogging in the morning can see whether they are going faster or slower than other noble Lords on the same circuit. One has to recognise that there are real advantages from having this geophysical data. I would not be concerned if everybody knew the colour of my front door.

Lord Wallace of Saltaire: My Lords, during the Second World War—a period in which many members of the Conservative Party still appear to live—a suspicious foreigner taking pictures of houses would have been stopped by some doughty Britain such as Mark Francois and challenged in case he was a German. There were, and surely still are, some security questions to answer. Is it not proper for the Government to promise us a review of this? In the meantime, could the Minister tell us whether British map readers, satellite users and so on can discover as much detail about houses and critical national infrastructure in Russia and China as they now can about us?

Lord Young of Cookham: On the first question raised by the noble Lord, I refer back to my original Answer. I said that part of this is about considering both risks and opportunities for current arrangements for access to mapping data. In this country, because of the excellence of Ordnance Survey, there are relatively few commercial marketing organisations doing this work. Most of them build on the data from Ordnance Survey and add value to it. What knowledge we have of critical installations in Russia is a matter for the MoD, rather than a humble Minister in the Cabinet Office. But in the light of the views expressed on both sides I will go back and double-check the information that I have been given.

Lord Harris of Haringey: My Lords, I fear that this is a case of your Lordships’ House trying to shut a stable door that has long been open. The Minister has highlighted our increasing dependence on global navigation data, whether while jogging or whatever else it may be. But this is about not just noble Lords jogging or trying to find their cars but about the maritime world, trains and everything else that depends on GNSS data. How far have the Government got in implementing the recommendations of the Blackett review of the extreme dependence of our national infrastructure on GNSS data, in particular in the financial sector, which would collapse if that data was interrupted?

Lord Young of Cookham: The noble Lord makes a valuable point. As I said in my original reply, we have established a new Geospatial Commission and it has a  number of objectives. If one looks at its five objectives, which I will not read out, one will see that they include the issue that he mentioned. At the risk of using jargon, which I criticised the last time I was here—and because he makes a valuable point—high-quality, cross-cutting geospatial data and ecosystems are fundamental building blocks of our vibrant and innovative digital economy.

Fly-tipping
 - Question

Bishop of St Albans: To ask Her Majesty’s Government what assessment they have made of the impact caused by fly-tipping on areas of outstanding natural beauty, following reports that the Woodland Trust has spent over £1 million on cleaning up fly-tipping over the past five years.

Lord Gardiner of Kimble: My Lords, the impact of fly-tipping is grave wherever it occurs. It blights local communities and the environment, and tackling fly-tipping is a government priority. Defra’s recently announced resources and waste strategy outlines our approach to tackling waste crime, including specific proposals to prevent, detect and deter fly-tipping. This month, we gave local authorities and the Environment Agency powers to issue financial penalties to householders who fail in their duty of care and pass waste to fly-tippers.

Bishop of St Albans: I thank the Minister for his reply. Having said that, the statistics from local authorities show that over half of them have not had one successful prosecution for fly-tipping. They say that it is not about a lack of law, regulation or anything else; it is a lack of resource. They simply do not have the ability to use the powers they have already got. What can Her Majesty’s Government do to break through this impasse and address this terrible problem, which we face right across the country?

Lord Gardiner of Kimble: My Lords, I entirely agree with the right reverend Prelate. The fly-tipping and littering that we see in our country is unacceptable. One example is that of partnership. For instance, in his own diocese, the Hertfordshire Waste Partnership has brought together a range of organisations to agree on a common approach to tackle fly-tipping. It has seen a fall of 18% in incidents from 2016-17 to 2017-18. On local authority enforcement actions, there are over 300,000 investigations and a lot of hard work is going on. Partnership is the way that we are going to tackle this.

Baroness Young of Old Scone: My Lords, as chairman of the Woodland Trust, I can confirm what the right reverend Prelate said. This is a growing problem not just in AONBs but right across our woods and open countryside. It has got worse as local  authority cuts have meant that waste disposal services are less readily available, particularly for green waste, which in many authorities is now charged for. As well as giving additional powers to local authorities, will the Minister seriously consider whether the resource constraints are a problem? The public also now need to be enlisted in much greater numbers to control this issue. Will he launch, together with local authorities, the Environment Agency and Crimestoppers, a public awareness campaign to ensure that the public report incidents—with vehicle numbers, where possible—and that, when they are approached by a white van man or a building contractor who will dispose of waste on their behalf, they personally check that that contractor is licensed and will take the waste to a licensed site? I commend to all noble Lords in the House today the idea of following the skip to the tip. It can be a very interesting journey.

Lord Gardiner of Kimble: I agree with a very considerable amount of what the noble Baroness has said. We need to educate people much more: one in five people consciously drop litter—one in four fail to tidy, or place, their litter—so there is a lot of work we need to do to educate. We are working with local authorities because we think that is the way forward. I would endorse the Great British Spring Clean of March and April as a way in which civil society can get much involved.

Lord Robathan: My Lords, I am delighted to hear the Minister endorse the Great British Spring Clean, but will he get Her Majesty’s Government to encourage every school to get involved in it, so that children are educated? Before he answers that, I will endorse what the noble Baroness, Lady Young, said. As a member of the Woodland Trust, I think that fly-tipping is absolutely appalling, whether on Woodland Trust territory or anywhere else.

Lord Gardiner of Kimble: Again, I agree with my noble friend that there is a lot that needs to be done. It is worse in urban areas than rural areas, but wherever it is, it is unacceptable.

Baroness Bakewell of Hardington Mandeville: My Lords, where fly-tipping occurs on local authority land, such as country parks, the ratepayer picks up the cost; where on private land, it is the landowner who pays. To what extent do the Government agree that the problem is related to the increased cost of waste disposal, reflected in the cost of skips, which are an additional burden to many small trade-related firms? Does the Minister agree that an approach to ease the commercial recycling and associated costs, plus the availability of suitable disposal locations, might help to alleviate the situation?

Lord Gardiner of Kimble: My Lords, the resources and waste strategy engages a lot of that area. Interestingly, although during the lifetime of this Parliament £200 billion is going to local authorities, although not ring-fenced, we clearly want to be looking at this. We have asked WRAP to look at these matters, because the evidence  does not show that it is about resources; it is about using the actions that can be taken. There is a whole range of actions, with increased fines, that is going to be very helpful.

Lord Mackenzie of Framwellgate: My Lords, given that a lot of fly-tipping takes place on private land—serious fly-tipping, at that—does the Minister agree that it would be useful to use more technologies such as discreet cameras with number plate recognition systems? Would he encourage the police to co-operate with landowners in this regard, and make it clear that when these people are detected the penalty deters them from making it worth while in the future?

Lord Gardiner of Kimble: The noble Lord is absolutely right. That is why, as part of the detect part of the strategy, we are developing a mobile app alongside landowners for reporting fly-tipping incidents. We are working with the Judicial Office, because we think that magistrates need to be effectively trained in environmental offences and take tougher sentencing and penalties.

Business of the House
 - Timing of Debates

Moved by The Earl of Courtown
That the debates on the motions in the names of Lord Whitty and Lord Hunt of Kings Heath set down for today shall each be limited to 2½ hours.

Earl of Courtown: My Lords, in the absence of my noble friend the Leader of the House, who has left to attend Lord Carrington’s memorial service at Westminster Abbey, I beg to move the Motion standing in her name on the Order Paper.
Motion agreed.

Domestic Abuse Bill
 - Statement

Baroness Williams of Trafford: My Lords, with the leave of the House, I shall repeat in the form of a Statement the Answer to an Urgent Question asked in the other House yesterday.
“The landmark draft Domestic Abuse Bill, which we published last week, will help transform the response to these horrific crimes. It is aimed at supporting victims and their families and pursuing offenders, to stop the cycle of violence. The Bill will cement a statutory definition of domestic abuse that extends beyond violence to include emotional, psychological and economic abuse. It does not create new criminal offences in relation to domestic abuse, because those offences are already settled law—such as Section 18 GBH, coercive and controlling behaviour and even, in the saddest of cases, murder. The offences are all devolved.
In line with existing criminal law, the provisions of the draft Bill extend to England and Wales only. Contrary to the suggestion that may be in the honourable Member’s Question, there has been no change in the territorial application of the Bill compared with proposals in the Government’s consultation published last spring. This was made clear in the consultation paper and reflects the fact that the subject matter of the draft Bill is devolved in Scotland and Northern Ireland.
We are currently in discussion with the Scottish Government and the Northern Ireland Department of Justice about whether they wish to extend any of the Bill’s provisions to Scotland and Northern Ireland respectively. We are seeking to establish a Joint Committee of both Houses as soon as practicable to undertake pre-legislative scrutiny of the draft Bill, and I encourage all honourable Members to contribute to the process”.

Lord Kennedy of Southwark: My Lords, I thank the Minister for repeating the Answer to the Urgent Question taken in the other place yesterday. The citizens of Northern Ireland deserve the same rights enjoyed by everyone else in the United Kingdom, but, today, they do not benefit from legislation on coercive control or stalking, and the controversy over the legality of abortion carries on. This is not right; it is unfair and it is unjust.
Can the Minister explain to the House why, in the absence of a functioning Executive in Northern Ireland, the Government are not proposing to extend the law as outlined in the draft Domestic Abuse Bill to Northern Ireland? Will she comment on suggestions that it is a device to prevent the importantly won freedoms and protections that I referred earlier being debated and considered in Northern Ireland and extended there as part of the Bill?

Baroness Williams of Trafford: The noble Lord will know that this is a devolved matter. Therefore, in order to for it be extended to Northern Ireland, the Northern Ireland Executive would have to request it through a legislative consent Motion. We know that this is a sensitive matter. We do not want to impose anything on Northern Ireland that is not already provided for. We respect the devolved process in Northern Ireland, which is why we have made the decision that we have. It has been a long-standing process in this area of law.

Baroness Barker: My Lords, this week 28 women will come from Northern Ireland to Britain to have health treatment that they should be able to get at home. They do so because the definition of abortion in Northern Ireland is so tightly drawn that it does not include cases of foetal abnormality, rape or incest. If they were to seek an abortion, they could face a sentence up to a maximum of life.
That is unacceptable. It is unacceptable that women in Northern Ireland do not enjoy the same human rights as those of us in the rest of the United Kingdom. Will the Minister comment on a Cabinet Office source being quoted in the Sunday Times as saying that they,
“foresaw the potential for the legislation to cause problems for the DUP”?
Does she think it right that the human rights of the women in Northern Ireland should be sacrificed to placate the DUP?

Baroness Williams of Trafford: As I said to the noble Lord, Lord Kennedy, this is nothing to do with placating the DUP; it is about the laws that are currently in place. Let me get back to what the Bill does: it tackles domestic abuse in all its forms. The matter is devolved. I recognise that it is an incredibly sensitive issue on all sides of the debate. Abortion legislation is devolved. I hope that a Northern Ireland Executive are established as soon as possible so that they can take on this legislation through a legislative consent Motion if they wish.

Lord Pannick: Could the Minister identify whether there are any provisions in this draft Bill which, in the Government’s opinion, are not appropriate for enactment in Northern Ireland? Could she also confirm that this draft legislation was announced in the Queen’s Speech in June 2017? Can she give the House some indication of when she thinks this legislation will be enacted?

Baroness Williams of Trafford: The draft Domestic Abuse Bill will be discussed for pre-legislative scrutiny in a Joint Committee of both Houses. That process should take 12 weeks, and thereafter the Bill should be introduced. As to whether any provisions are not appropriate for Northern Ireland, it is a devolved matter through legislative consent—as I have said. Northern Ireland can take up the provisions in the Bill, and that would be the process.

Baroness Lister of Burtersett: My Lords, it took three attempts yesterday to get a response from the Minister on the absence from the draft Bill of any measure to address the point made in the original consultation document—that insecure immigration status may also impact on a victim’s decision to seek help—and then the Minister’s answer left us none the wiser. Could the Minister now give us a clearer explanation why the draft Bill does not have any measure to address the problems faced by this particularly vulnerable group of women who are of great concern to organisations on the ground? Could she assure us that she will look at this issue further?

Baroness Williams of Trafford: The Bill does not differentiate between the types of women who might suffer abuse, but looks at how we treat the abuse itself. The noble Baroness will probably know that there is a destitute domestic violence concession, which is available to support people who may otherwise be forced to remain in a relationship with an abusive partner on whom they are financially dependent. I look forward to discussing those issues with the noble Baroness when the Bill comes to this House, as I am sure that she will be in her place challenging me.

Baroness Burt of Solihull: My Lords, I asked the noble Baroness the Minister, Lady Vere, about the jurisdiction of this Bill as it applied to migrant women  when it arose at Questions last week. I was heartened by her openness to consider the possibility of extending jurisdiction during the pre-legislative scrutiny stage. As my noble friend Lady Barker said, there is a whole group of British citizens to whom this legislation may not apply—women and men in Northern Ireland. Can the Minister confirm that the Government will be similarly willing to consider including the plight of every citizen in the pre-legislative scrutiny stage of the Bill?

Baroness Williams of Trafford: The noble Baroness will know that the ETJ will cover offences committed by a UK citizen against someone abroad. I am certainly happy to have a conversation with the noble Baroness on extending the ETJ. I do not want to speak for my noble friend, but I am not sure that she would have committed to extending it.

Baroness Butler-Sloss: My Lords, I am the chairman of a forced marriage commission. Do the Government recognise that in forced marriages there is often domestic abuse, that the many victims of forced marriage who suffer domestic abuse need special care, and that the current refuges for them are not necessarily all that satisfactory?

Baroness Williams of Trafford: The noble and learned Baroness is absolutely right; I have seen this for myself. I have seen people who enter into a marriage—not necessarily a forced one—and have no leave to remain. They cannot speak English, and their passports have been taken from them. I absolutely recognise the point that the noble and learned Baroness makes, and look forward to discussing it during the passage of the Bill.

Baroness Gale: My Lords, the Bill is very welcome; it has taken a long time to come to us. Will the Minister confirm that, when it is passed, the Istanbul convention will be ratified? In the past she has said both that it would be and that it is a very narrow Bill.

Baroness Williams of Trafford: I will not only confirm that but thank the noble Baroness for all the work she has done on this. She has challenged me on this for probably the past three years. I hope that she and I together will get there.

Lord Kilclooney: In the context of this draft Bill, can the Minister confirm that she welcomes contributions from noble Lords who want direct rule in Northern Ireland?

Baroness Williams of Trafford: That would be a matter for each noble Lord to articulate. We do not wish to see direct rule in Northern Ireland; we wish for an Executive to be re-established. It would be a terribly retrograde step to go back to direct rule in Northern Ireland. I think that the point the noble Lord is making is about imposing law in Northern Ireland without legislative consent—and we do not wish to do that.

Lord Reid of Cardowan: My Lords, I very much recognise the sensitivity of the issues mentioned by the Minister, and I am also a long-time supporter of devolution. But does the Minister recognise the bemusement of many, that in the greatest issue facing this country at the moment, Brexit, we have come to an impasse upon the insistence that there should be no difference between Northern Ireland and the United Kingdom, yet on occasion after occasion, as in this case, Ministers come to this Dispatch Box and tell us that we cannot have the same laws in the Province as on the British mainland? Does the Minister see the paradox contained in that presentation?

Baroness Williams of Trafford: The noble Lord might point out that in some ways this is a paradox, but in other ways it is because we respect the devolutionary process for Northern Ireland, and therefore we would not want to impose laws on the people of Northern Ireland that they did not wish to take. However, we hope in this situation that they might wish to take this up through legislative consent.

Social Housing
 - Motion to Take Note

Moved by Lord Whitty
That this House takes note of the case for a long-term commitment to increased provision of social housing to help to reduce housing costs, homelessness and housing benefit expenditure.

Lord Whitty: My Lords, this year marks the 100th anniversary of the Addison Act of 1919, which first gave general powers for local authorities to build and manage council housing. For decades, council housing was the ambition of millions of families in all walks of life, and for many it still is.
For my main text I have taken the recent report from Shelter’s Social Housing Commission. It starkly sets out how we got here, what are the consequences, and makes proposals for drastic and strategic action to restore the central role of council housing in our housing provision.
I am of course grateful that such a large number of speakers wish to speak in this debate, but I am particularly pleased to see a member of that Shelter commission: my noble friend Lady Lawrence. I look forward to her speech, as well as to the maiden speech of my noble friend Lady Osamor.
It is still the ambition for millions of people in the often exploitative and squalid private sector to obtain social housing provided by local authorities and housing associations. That is why 1.1 million households in England—about 4 million people—are on council waiting lists and desperate for a council house. In London, the ratio of those households on the lists to available property is over 20:1, and in central London it is even higher. Lest this is seen as a purely urban issue, the  CPRE estimates that at the present rate it will take 133 years to clear the current waiting lists in rural counties of England.
In the last few decades, from the 1980s onwards, social housing—council housing in particular—has been first disparaged by Governments and media, then curtailed, and then directly attacked. Successive Governments share some of the blame, but the inheritance of the 1980s has done the greatest damage.
Building of social housing has fallen from an average of 126,000 per annum to a few thousand a year—fewer than 7,000 last year. Originally, the Thatcher Government’s right to buy saw 3 million council homes lost, without the proceeds being used to provide for their replacement. Stock transfers and allocation of management to ALMOs has also often removed councils from their housing management role, sometimes with disastrous consequences.
Successive Governments have championed the growth of home ownership, and I do too, but that growth has reached saturation point and gone backwards. It has fallen from 70% to 63% in recent years. In the private rented sector, renting privately often means unaffordable housing costs. Indeed, even within the social housing sector, the insistence on “affordable rent”—which in practice works out at up to 80% of rapidly rising local private rents—has meant that housing costs have been too great for many families. In the private sector, it has meant multiple tenants in overcrowded rooms or even, in some cases, in sheds and outhouses. At the end of this line, it means the tragically burgeoning number of homeless on our streets, which has doubled over the past few years and, as we have seen in the figures today, has gone up again. Those figures are regarded by almost everybody as an underestimate.
Meanwhile, from the Government’s point of view, over the past three decades, state support for housing has not diminished but has shifted dramatically from subsidies for building, improving and managing homes to providing welfare benefits for tenants. Instead of the Exchequer investing in building for the future, state spending goes on an escalating benefit bill, a large proportion of which is now going to private landlords, increasing housing shortages in town and countryside alike.
I often feel angry about this, and the last time I intervened in a housing debate, I just had a rant because I had only four minutes. Colleagues today have only three minutes, so I expect some more of those as well. I was blaming successive Governments, but also the overconcentration of housebuilding and developers, so that their ability to evade any social housing targets has grown. The difficulty that arises for local authorities and housing associations when dealing with private developers is that developers are in a position of strength to argue for a diminution in social housing.
Many simply blame the right to buy; I do not completely. In principle, the right to buy gave the possibility of home ownership to a lot of people who would not otherwise have had it, but local authorities need the right to suspend it and, as noble Lords will know, in Scotland and Wales it has been abolished. The main opposition to right to buy as it has been  practised has been because of the failure to use the proceeds to develop new social housing. If we had ploughed all that money back, we would have thriving mixed tenure communities, instead of which we have monolithic areas and misery in the private rented sector.
We often talk about social housing in terms of individual tenants and families, but homes also form communities. I am in favour of mixed tenure communities, but I am not in favour of new developments and regenerations drastically reducing the provision of social housing. For three decades, provision of housing overall in all forms of tenure has been inadequate; the Government acknowledge this, as do all political parties. We have created homes at only about half the rate of the creation of new households, but the social housing sector has suffered most, particularly council housing. Of course, other forms of housing provision ought, in a progressive policy, to play a significant part. Housing associations have a key role to play, as do the various schemes for shared ownership, and there is some scope for bringing back empty homes into use and conversion. But unless we have a strong and clear commitment to a long-term programme of building and converting for new social dwellings at social rent, we can solve neither the housing crisis, nor the social crisis, nor the problem of escalating housing benefit, nor ultimately the problem of homelessness on our streets and of hidden homelessness in many families up and down the country.
The recent Shelter report sets this problem out squarely and comes up with some proposals. In recent months and years, the Government have shown some recognition of the need to build more council homes, particularly in their recent document with a foreword by the Prime Minister herself, but the reality is that the number of homes being brought into being by councils has continued to diminish. The Shelter report calls for a major long-term programme; it envisages 3.1 million social homes being built, mainly by councils, over the next 20 years. That requires a drastic shift to capital and management investment in council housing, away from the growth in housing benefit now caught up, regrettably, in the difficulties surrounding universal credit.
That target is ambitious but it is shared by almost every housing commentator. I was slightly surprised to find, for example, the Centre for Social Justice—normally seen as a right-wing organisation—coming out with not quite the same but rather similar targets and propositions on land reform. Most experts in this field realise that we cannot reverse the current problems in the housing market without councils playing a major role in the building programme. Since the 1920s, they have not: council building has fallen drastically and is now close to zero. The problem has got worse and other solutions, such as the growth of home ownership, are now grinding to a halt.
The situation has been aggravated by two other aspects. The Government have started to address one: the absurd restriction on local authorities building and investing in social housing. That was partly reduced in the recent Budget but it will take some time for that to have any effect. The other dreadful consequence of austerity has been local authorities losing a lot of expertise in their housing, architecture and planning  departments, meaning that they are less able than they were in the past to commission new builds and improve their existing estates. That also needs to be reversed; the Government need to see that the money provided to local authorities is there to do just that.
This issue requires a long-term strategy, as Shelter and others have recognised, but the Government and everyone involved in the building industry and housing provision must ensure that the strategy starts now so that we build enough homes for the next generation—homes that families can afford and in which they can be safe and create effective and functioning communities. I will give other speakers an extra four minutes because my voice is going but I hope that they will support the provisions of the Shelter report and my speech. I beg to move.

Lord Porter of Spalding: My Lords, I declare an interest as the leader of South Holland District Council and the chair of the Local Government Association. I am also a small-scale private landlord, for what it is worth. I thank the Opposition for using their time to control the agenda of the House and use it for this most important of subjects.
It is an undisputable truth that every child in this country deserves to be born in a decent, safe, secure and affordable home. For the vast majority, council-owned or social landlord-owned properties are probably the only way to meet that affordability criteria. As the noble Lord, Lord Whitty, said, successive Governments over the past 40 years have fallen out of love with council houses for various reasons. That has not gone well for those of us who believe that safe, secure and affordable homes are best provided through the social sector. We saw at the start of the coalition Government and the recession that the post-war consensus that we would always invest in bricks and mortar was changed to an investment in tenants. That is why we are now spending, or wasting, more than £20 billion a year on housing benefit.
Probably the most reassuring statement from the current Prime Minister was made two years ago at the party conference. She is the first serving Prime Minister that I can recall to have a positive conversation about council houses. She talked about the benefits to children if they are able to grow up in a council house. That is the first time I can remember such a statement. She followed it up at last year’s party conference by doing the one thing that will mark her out as probably one of the best Prime Ministers of the 21st century: she reversed the actions taken by successive Governments to prevent councils borrowing against the assets they already own. Our councils own a few million houses and we should be able to sweat that asset. She is the first Prime Minister to turn this around and she must be remembered for that. However you dress it up, she will be largely responsible for hundreds of thousands of children in this country being able to grow up in decent, safe, secure and affordable homes.
I agree with most of the other comments made by the noble Lord, Lord Whitty. Like him, if I stand up for too long I will rant, so I will add one of my minutes to the four that he has already offered back to the House.

Baroness Warwick of Undercliffe: My Lords, I congratulate my noble friend Lord Whitty on securing this debate and I look forward to the maiden speech of my noble friend Lady Osamor. I declare an interest as the chair of the National Housing Federation.
I too want to refer to Shelter. Its social housing commission—my noble friend Lady Lawrence was a commissioner—recently set out graphically the damning consequences of poor provision of social housing, including increased homelessness. This is clearly a crisis and the true cost is staggering. The Government spend billions of pounds a year on housing benefit, much of it going to private landlords. Councils are spending hundreds of millions on housing homeless families. In stark terms, the housing crisis costs lives. Recently a homeless man died just outside this building.
The National Housing Federation and Crisis have shown that, to meet demand, we need to build 340,000 homes a year, but numbers alone will not solve this. The type of tenure is vital to tackling the root of the problem. We need to build 145,000 affordable homes a year and 90,000 must be for social rent. Last year, we built just 42,000 affordable homes. There are no quick fixes. We need a long-term, joined-up plan to build vastly more homes for social rent.
I want to use my three minutes to identify briefly some key issues and ask the Minister some questions. Housing associations will play their part as the largest providers of social homes, and the Government too have made a commitment to build 300,000 homes. How many of them will be genuinely affordable? How much investment has the Treasury calculated will be needed? Each area faces its own unique challenges, which require local solutions. In some places regeneration is needed, not new build. Does the Minister agree that different solutions are required, including investment for regeneration? Partnerships with local authorities are vital. The removal of the housing revenue account cap should empower local authorities and housing associations to work together to tackle the crisis. However, barriers remain. Will the Government reform the Land Compensation Act 1961 so that a fairer proportion of the uplift in land value can be shared with the local community, including for affordable homes? Will the Minister commit to delivering 50% of affordable housing across public sector land?
The freezing of working-age benefits, the design of universal credit, the spare room subsidy and changes in the way benefits are paid have all made life harder for many tenants. They have certainly contributed to, if not driven, the huge rise in homelessness. I am pleased that the Government have promised to provide impact assessments in their rough sleeping strategy. Can the Minister tell the House what data he and/or DWP have on the impact of benefit changes on homelessness?
The Government have taken positive steps to invest more in social housing, but to provide a sustainable solution they must act on longer term funding for genuinely affordable homes and on access to land. My final question therefore is: will the Minster commit to doing so in the upcoming spending review?

Baroness Grender: My Lords, I congratulate the noble Lord, Lord Whitty, on securing a debate on such a significant issue. For too long, in all political parties, social housing has been the poorer cousin of affordable housing—which, as we know, is no such thing, being 80% of market rate. Having spent over 30 years plundering stocks of social housing—with the high peaks of sales in 1981, 1989 and 2003—all political parties have failed abjectly to replace those stocks. Every political party has been guilty of inaction when in power and has failed to properly acknowledge that. The change in policy in 2012 to replace properties sold with affordable housing was in effect sticking a broken finger in a dam long since washed away. From the JRF to the IFS, calls for yet greater numbers of social housing properties to solve this are matched only by the Treasury’s increasing deafness.
Gordon Brown’s golden rule was but one example of the negligence the Treasury has shown for over a quarter of a century. The IFS suggests that this has suppressed social housing build over a long period. In 1996 I met with Gordon Brown and lobbied him on this issue. He was on the eve of an historic win, with an eye-watering majority and money to spend. The lack of commitment to turn this issue around, in spite of progress in other areas such as homelessness, was tragic. Today we have a housing benefit cost of £21 billion, down from £25 billion because of harsher criteria. Any normal business would look at these swingeing levels of ongoing current expenditure and ask: why is there no capital expenditure to turn this around?
So what of the future? First, all parties must accept that we have failed over a long period on this crucial policy. Secondly, all parties must work together with a real target for social housing instead of the usual arguments over the least lamentable record. It often sounds like a dispute about the size of the head of a pin rather than the sledgehammer required. Only yesterday we saw this in a speech from James Brokenshire promising £500 million—money that is not new and certainly not enough. Thirdly, the Treasury must be held to account and use the forthcoming spending review to make substantial change. Fourthly, no plans by any political party will deal with the immediate and urgent shortfall. The private sector must therefore be supported to be fit for purpose. Given that the main cause of homelessness is the end of an assured shorthold tenancy, this requires urgent attention and I look forward to hearing the results of the Government’s current review.
The long-awaited ban on fees for tenants is a great first step, but more needs to be done. Failure to act urgently on this, on a huge scale, means another Christmas with 130,000 children in Britain in temporary accommodation—a number that shames us all.

Bishop of Chelmsford: As Bishop of Chelmsford, I am also proud to be the Bishop of Becontree, Harlow and Basildon, three of the nation’s boldest attempts by policymakers in the last century to address the housing needs of London and the south-east. When Becontree was built in the 1920s, it was Europe’s largest public housing development.  The Government were then building homes fit for heroes after the First World War, and London County Council had a bold vision for 27,000 new homes and the infrastructure that went with them, which we do not see in housing estates today. There are many being built across Essex. It is great to move in, provided that you do not own a car—there is nowhere to park it—and provided that nobody who ever visits you has a car, because there is nowhere for them either.
The era of large housing estates has gone, but so has the vision to build proper communities. I therefore very enthusiastically support the Motion from the noble Lord, Lord Whitty, and the need to increase our commitment to provide social housing. This debate is very timely. We all see the reason for this in the terrible rise in homelessness. I pay tribute to the work done by churches and charities up and down this country to support those who are homeless.
Until fairly recently, most of us would grow up, live, work and raise a family in the same place, but we now live networked lives. We therefore end up gravitating towards living beside people who look and think as we do. But the danger is that a networked, aspirational society becomes a disintegrated society, a society with rising levels of aspiration but correspondingly higher levels of discontentment and unhappiness. Let me put it plainly: there is something wrong and we store up great trouble for ourselves when people cannot even aspire to live in the communities where they grew up.
Creating more diverse but integrated communities is challenging but it provides a better context for human flourishing, so please forgive me for making a theological point: you cannot be yourself on your own. The only way we can fully be what we are meant to be is in community with each other. The answer is plain and it is, of course, our common expectation: builders and developers must ensure that a significant proportion of the dwellings they build is affordable social housing.
However, we know that this is not happening. Let me point out one reason that we could address. Using what are known as viability assessments, developers can avoid or reduce the proportion of dwellings set aside for social or affordable housing, arguing that such housing undermines the overall profitability of the development. I am not suggesting that builders develop sites without profit but we could look at this—it could be more transparent—and then we could build not only housing developments but communities.

Baroness Bloomfield of Hinton Waldrist: I too join my noble friend Lord Porter in thanking the noble Lord, Lord Whitty, for using the Opposition-day debates to focus on this important and topical subject.
It is clear to us all that successive Governments have not done enough to build more affordable and social housing since the stock was depleted by the right to buy. With only three minutes, l am going to focus on the present and ways in which the Government could create a more sustainable model for the provision of social housing than currently prevails.
There are three elements to the cost of housebuilding: the land, construction and the profit margin. As the costs of both land and construction have escalated,  profits—the incentive to build—have declined. When those are added to the many problems within the planning system, it is difficult to see how the Government will meet their target of building 300,000 new homes per year without both a new financial model and changes to the planning system.
The London Mayor Sadiq Khan’s worthy but ill-advised aim to require 50% of new homes built to be affordable or social makes the finances of a scheme completely unworkable and has resulted in a 23% decline in housing starts.
Of the three component costs, we must find a way of reducing the cost of land and ensuring that public land is used for future social housing needs, particularly in London, where 80% of boroughs report that access to social housing for their homeless clients is very difficult. I do not see an argument for subsidising or fast-tracking land acquisition by the private sector in return for an increased proportion of social housing. This merely leads to a perpetual housing shortage and escalating rents.
If the aim is to provide genuine social and affordable housing, then public land should be treated as the Crown Estate treats its land—as a long-term asset which is managed and looked after for long-term benefit, in this case of the community. It can be used for the provision of housing, and the nomination rights of who can occupy this housing should remain with the local authorities or housing associations.
A potential model is that of a community trust partnership. This model is based on using long-term institutional funding—say 25 to 35 years—to provide multi-tenure housing in urban and metropolitan areas. The CTP would bring funding and expertise to assist a local authority to develop land that it already owns. However, the local authority would retain ownership of the land, guaranteeing a return to the investor over the long term in the form of rents, retaining enough income to cover maintenance and fees. The CTP would not need to allocate a majority of housing for private sale; rather, it would enable a balance between private first-time renters, affordable rents for key workers and social housing.
Finally, to address the component of construction costs, I direct noble Lords to the conclusions of the Science and Technology Committee in its excellent report on offsite manufacture for construction. The Government have a welcome presumption in favour of this in the construction sector deal. Benefits include faster delivery; better quality, lower cost, low-rise buildings; fewer labourers; increased productivity; improved sustainability of buildings and infrastructure; and less disruption to communities.
I hope that the Government’s commitment to offsite manufacture will be backed up by specific measures enabling this sector and its pioneering technology to flourish here and abroad, whilst at the same time introducing welcome competition to the housebuilding industry.

Lord Pendry: My Lords, it is most unfortunate that the terms of this debate, so ably moved by my noble friend Lord Whitty, are so broad that our time  to speak on such important matters is so limited. As a result, I shall focus my short remarks on the pressing need for the Government to resolve this housing crisis, so that we can see an end to the diabolical increases in homelessness and the deaths of homeless people that we have seen over the past eight years.
By the Government’s own figures, the number of people sleeping on the streets has more than doubled since 2010, and charities warn us that this is a strong underestimate. It is shocking beyond belief that the Government started publishing only last December the numbers of people who have been dying in this situation. The news that 600 people died while homeless in 2017 should chill us all.
The factors contributing to this are clear. We have a chronic undersupply of affordable housing following 40 years of failure in housing policy, driven in part by the ideological selling-off of our council houses. This Government have pushed the situation to breaking point, with their record lows in council housebuilding. Their cruel austerity measures and the capping of local housing allowance have exacerbated people’s inability to pay expensive private rents.
Councils are struggling to find social tenancies for the homeless, and more and more people are becoming homeless because they cannot afford to pay their rent. When serving on Paddington council in the early 1960s, I witnessed the inhumane activities of a certain Peter Rachman towards his housing tenants. Rachman has gone, but the spirit of Rachmanism is alive today in the extortionate rents of this housing crisis and the increasing number of people forced to live in shocking conditions. The Government’s attempts finally to address this crisis of their own making come too late. We must tackle the root causes of homelessness by committing to a long-term vision for the building of social housing, giving greater security to renters and ensuring that people have access to the benefits and support they need to help them keep their homes. If the Government cannot facilitate the most basic human need in our society—for people to have shelter—they must move aside for a Government who will.

Lord Bird: I welcome this opportunity to talk about social housing and I thank the noble Lord, Lord Whitty, for tabling the question for debate. Harold Macmillan responded to Rachman, who had died a few years before, by having a unified House that brought in the rent tribunal. The rent tribunal meant that people like me could rent a flat, disagree with the rent, go to the rent tribunal and spend three or six months playing around so that the landlord did not get his money. This led to a 40% fall in the amount of cheap housing in the private sector. Until that point, only 30% of the population of the UK was in social housing. Enormous pressure was put on social housing, which meant that local authorities, and then the increasing number of housing associations, dealt only with the desperate. That ended social housing once and for all. You then have a new form of social housing, full of ghettos of profoundly needy people, instead of it being sociable housing, as it was before, with a mix of tenants, including working people.
I was born in a London Irish slum. We eventually got a council flat in Fulham in 1956. In the block of flats that we lived in, there were policemen, teachers, our first parking warden, caretakers and lorry drivers, and mixed in with them were the needy—people who were disabled and so on. It was sociable housing. We lost sociable housing when, with the best will in the world, the Rent Act took out of circulation a large amount of private housing, putting enormous pressure on local authorities. The local authorities, unable to meet the housing need, said that people had to fulfil the most dreadful criteria to be given social housing. So the next generation of my family, who lived in Fulham, never got social housing. We have to avoid that situation.
We also have to avoid what happened in the 1970s and 1980s, when we pulled down the crap put up in the 1950s and the Ronan Points that went up in the 1960s. We have to be very careful how we do this. We can call for all the social housing that we want but let us make it sociable. When only 0.5% of children living in social housing will get to university, it means that we have the worst form of social engineering possible.

Baroness Osamor: My Lords, it is a great pleasure and privilege to make my maiden speech in this very important debate, secured by my noble friend Lord Whitty. I wholeheartedly support the aims of his Motion: I believe that a safe and secure roof over one’s head is a basic human right.
Since my introduction to this House, I have received a warm welcome from all sides, including from House officials and staff. I thank them all for that. I also extend my gratitude to my sponsors, my noble friends Lord Harris of Haringey and Lady Lawrence of Clarendon, and to my mentors, my noble friends Lady Wheeler and Lady Lister of Burtersett.
I am proud of my title: Baroness Osamor, of Tottenham in the London Borough of Haringey and Asaba in the Republic of Nigeria. It is a tribute to my late husband, Joseph, who died in a car crash, and to my father and mother.
I have been a proud member of Unite, my union, for over 40 years. It has afforded me many opportunities and I owe so much to it.
I was born in Nigeria in an era when very few girls went to school. My father, a progressive man, invested equally in all his children’s education, breaking down all cultural and social barriers when he ensured this for us. I left Nigeria in 1963 to join my husband in the UK. Against all odds, he had managed to rent a room in Tottenham, a place I still call home. I was a fully trained teacher and my husband was training to be a lawyer. On arrival in the UK, I experienced at first hand the hatred and discrimination against black people.
It was commonplace to see discrimination in housing in the 1960s, with adverts that stated, “No Dogs, No Irish, No Blacks”. During that era, the only viable housing option on offer for a young black couple was to accept very poor housing from landlords who exploited the bad situation. Most homes had no heating, no indoor toilet and/or no bathroom. We, like many  others, felt the isolation and desperation of being on the receiving end of countless doors being slammed in our faces.
In contrast, back in Nigeria there were military coups, followed by the Biafran war, which initiated the displacement of my family. My family’s home was taken over by the Nigerian military. These defining factors delayed the well-thought-out plan that my husband and I had to return to Nigeria.
Finally, my husband made that long voyage home but it proved his last ever journey. Sadly, we lost him in a fatal car accident. My husband’s untimely death meant that I was now a widow in the UK bringing up a young family. When I look back at that time of mourning, it was the solidarity from my neighbours and friends that kept me afloat. I have nothing but admiration for the people I lived side by side with.
It was at that juncture that my personal and political life collided, leading me to work on building improved social connections with my neighbours for the betterment of all our communities. Collectively, as a community, we lobbied and addressed the primary issues of concern that impacted on us all. My lived experiences of getting involved in community activities provided dividends and led to my securing a job at Tottenham Law Centre, which did lots of housing casework, including on disrepair and homelessness. One of my many duties was to work with the families affected by the sus laws of the 1980s. The law centre continued to work with these mothers and families to help improve their lives. Together, we established and facilitated the creation of jobs for many left-behind families. I am proud to say that together we set up enterprise workshops, a co-op, a defence committee, a mothers’ project, a nursery and a youth association.
I look forward to sharing my lived experiences and knowledge in future debates. My commitment to change is a motto that I believe underpins my life. I finish with this quote from Maya Angelou:
“You may not control all the events that happen to you, but you can decide not to be reduced by them. Try to be a rainbow in someone’s cloud. Do not complain. Make every effort to change things you do not like. If you cannot make a change, change the way you have been thinking. You might find a new solution”.

Baroness Lister of Burtersett: My Lords, it is a privilege to follow and welcome my noble friend, whose inspiring maiden speech, rooted in her lived experience, showed how much she will bring to our deliberations.
I strongly support this Motion, in particular with regard to homelessness. The National Audit Office drew attention to the,
“unquantified cost of homelessness to wider public services”,
including health. Unquantifiable is the cost to the physical and mental health of homeless people themselves, and to their lives, with ONS statistics showing a 24% increase in the number of deaths of homeless people over five years. For the growing number of female rough sleepers, some of whom have fled domestic violence, these health problems are often aggravated by sexual harassment.
The other week, the Nottingham Post headlined the health costs of homelessness in the city. It quoted Suzey Joseph, an outreach nurse employed by Framework, a local homelessness charity, who said:
“They get infections, organ failure and get sicker and sicker until they die on the streets”.
I met Suzey recently and was impressed by how she is helping homeless people to get the healthcare they need. Will the Minister undertake to look at this initiative as a possible model to promote through the Government’s rough sleeping strategy?
The causes of homelessness are of course multiple, and it has suited Ministers to hide behind the mantra of complexity when challenged on the role played by their own policies. But complexity does not absolve them of responsibility. Like my noble friend Lady Warwick, I am particularly concerned about the impact of social security cuts and restrictions, including the cap, the two-child limit, the housing and other benefits freeze, punitive sanctions, universal credit and devolution to local authorities of responsibility for emergency assistance—at least 28 have abolished their schemes and almost all the rest have cut back drastically.
The evidence from organisations on the ground, research and the NAO all points to,
“the impact of welfare reform on homelessness”,
to quote the Public Accounts Committee. The PAC thus recommended that DWP write to it,
“to set out what work it has undertaken to identify any elements of welfare reform that are having an impact on homelessness and what steps it has taken to mitigate them”.
The report back—a full half page—is totally unilluminating and says nothing about mitigation.
In December, the Secretary of State for HCLG denied that the rise in rough sleeping is a political failure linked to government policies but, a week later, he acknowledged that there may be a link to social security cuts and that we,
“need to ask ourselves some very hard questions”,
as to why there are so many more people on the streets.
What progress have Ministers made in coming up with answers, over a year since the PAC asked them to investigate the link between homelessness and so-called welfare reform? As social security cuts push more and more people further and further below the poverty line, they are undermining the Government’s own rough sleeping strategy and thereby contributing to the rising death toll on our streets.

Baroness Thornhill: My Lords, I draw the House’s attention to my declaration of interest as a vice-president of the Local Government Association. From these Benches I welcome the noble Baroness, Lady Osamor, to the House. I am sure that her authentic voice will ring through for years to come. I thank the noble Lord, Lord Whitty, for this opportunity to contribute in a very small way to this really important debate.
I am in no doubt that the Government are committed to increasing the delivery of new homes—the legislation and consultations over the last four years have been quite prolific—but my questions are as follows. Are the  Government committed mainly to increasing home ownership as the core plank of their housing policy, or do they recognise that the country needs a strong social rented sector? If it is the latter, is that actually being left to local authorities to provide only if they choose to do so? How are the Government working to overcome the well-documented affordability crisis?
A quick calculation shows that the majority of government housing money is spent on schemes to promote home ownership, including shared ownership, starter homes and Help to Buy, to name but a few. The amount of money spent on housing benefit is also rising as the private sector as a provider is expanding, while the amount spent on social housing has significantly decreased. I acknowledge that the lifting of the borrowing cap in October was helpful, but I do not believe that local government alone can transform the social rented sector without considerable subsidy and a real plan of action. I fear that we are being set up to fail despite our best endeavours and some excellent innovative schemes, such is the scale of the task nationally.
My own authority has been fortunate in receiving grant in the last round of funding, which will help us to build 55 socially rented homes. That is small beer, though; we were averaging 200 a year before the damaging viability clause mentioned by the right reverend Prelate was introduced. To make those 55 homes viable we have had to gift the land, borrow £6.7 million and contribute £2 million, and we have received £3.3 million in grants. That level of borrowing and contribution is beyond many district councils and small housing companies.
Many councils are reluctant to build for social rent when properties can be lost to them via right to buy within three years. Will the Government consider allowing councils to set their own right-to-buy policies for their area, or at least allowing councils keep 100% of right-to-buy receipts? In future assessments of housing need, will the Government specify for all local authorities the need for social housing and set clear objectives for the number of social homes that they wish to see built?

Lord Best: My Lords, I thank the noble Lord, Lord Whitty, for this debate. I congratulate the noble Baroness, Lady Osamor, on her powerful maiden speech. I draw attention to my housing interests on the register.
I spoke last week about social housing in the valuable debate introduced by the noble Lord, Lord Scriven, so I will concentrate today on a single issue: land value capture. Sir Oliver Letwin, in his radical report of last December, recommends that for future large sites local planning authorities should have the power to acquire sites at a maximum of 10 times their existing use value—for example, not £1 million or £2 million an acre but, say, £80,000 or £100,000 an acre. This would make it possible to provide thousands more genuinely affordable homes without frightening the Treasury.
The authority would create master plans and design codes. To deliver those, it would deploy a special development company to put in the infrastructure of the land being parcelled out, with individual parcels sold to builders and social housing providers to create  housing of different types and tenures. Sir Oliver recognises that when landowners are unwilling to sell on these terms, compulsory purchase will be necessary.
The current CPO system needs overhaul, not least because it requires, under the Land Compensation Act 1961, that the valuation of sites subject to compulsory purchase must include “hope value”—the prospective uplift which could follow from a change of use. To achieve the Letwin model, a new Act of Parliament to amend the 1961 Act will be necessary. In the meantime, can land value be captured in any other ways?
The Mayor of Cambridgeshire and Peterborough, James Palmer, is doing deals with landowners to secure sites at just eight times agricultural value, rather than 100 to 200 times, and the mayor will switch locations for development if landowners are recalcitrant. However, planning decisions will often be pre-empted by infra- structure constraints, emboldening some landlords to hold out for wildly inflated prices.
An alternative opportunity is to use legislation that already exists. In 2016 and 2017, the noble Lord, Lord Taylor of Goss Moor, and I secured two amendments to planning Bills, with government support. These retain the still operative power in the New Towns Act 1946 which enables the Secretary of State to acquire land for a new settlement at existing land value, and now gives that power to development corporations set up by local authorities.
The Government are now canvassing bids from councils to use this route to capture land value and create sustainable mixed-tenure new communities. These can demonstrate that, if only land value can be captured, all our housing developments could be far better and far more affordable social housing could be created without overwhelming the public finances. An update on this issue from the Minister would be much appreciated.

Baroness Lawrence of Clarendon: My Lords, I thank my noble friend Lord Whitty for securing this debate and congratulate my noble friend on her maiden speech. I would like to lend my voice to this debate. This topic is broad and complex, so I feel that I can only touch upon one or two aspects of this matter, as time is limited today.
The subject of social housing is especially valued to me, as I am fortunate enough to be part of the independent commission put together by the charity Shelter to address the current public housing crisis in the UK. As part of the commission, we urge politicians not to remain idle at a time when half of young people are forced to live at home longer because of the shortage of affordable housing, as they have no chance of ever buying a house. The report also shows that private renters on low incomes spend an average of 67% of their earnings on rent. In our findings, the commission found that there can be a certain stigma attached to social housing. However, I believe that social housing can be seen as the key to a stronger community. In fact, many would say that social housing is essential in helping to rebuild society.
Moving forward, access to social housing is crucial for those in greatest need and should be a priority. Through various case studies, the commission also  heard many circumstances where tenants, both private and social, are being continuously overlooked by landlords and legitimate grievances are being routinely ignored. Red tape and indifference mean that many tenants are waiting for unacceptable lengths of time before their cases are considered. Some tenants have talked about waiting up to eight months before their complaints can be looked at.
Surveys show that many private tenants who raise any issues regarding inadequate living conditions are then likely to be asked to move on by their landlord. Research by Citizens Advice found that 46% of private renters who made a complaint about the condition of their home, such as about damp or mould, were issued with an eviction notice within six months. Tenants are asking for complaints to be taken seriously. As such, part of the solution would be the formation of a tenants’ panel. It seems that there is a distinct lack of regulation in the housing sector, and reform is clearly vital. It is imperative that the Government should actively support the formation of a tenants’ panels to share good practice.
We cannot fail to see first-hand the dire situation of the homeless epidemic in this country. I am sure I am not the only person who passes the unfortunate individuals at the entrance to the corridors of power each morning. Sadly, I learned that a gentleman passed away in the underpass that leads to the Palace of Westminster just before Christmas.
Shelter’s report indicates that 277,000 people in England are homeless, with eviction from a private tenancy the most common cause. The report indicates that, without increased levels of social housing, this number is likely to increase. Ultimately, if more social housing is not delivered, it will have a devastating impact on people’s lives, above all the continuing tragedy of homelessness.
In conclusion, I know we will not solve the housing crisis overnight. In fact, our reports suggest that a 20-year programme is required to deliver the scale of social housing reform needed in the UK. However, once implemented, this reform would allow the benefits of social housing to be accessible far more widely, thus benefiting those in need. We would like to see the Government accept the report and reform launched earlier this month as a solid proposal for building a just society for all those who seek better living conditions for themselves and their families.

Lord Garel-Jones: My Lords, I join other noble Lords in thanking the noble Lord, Lord Whitty, for introducing the Motion and above all congratulate him on the tone in which he introduced it. The challenge society faces in the social housing sector cannot be laid at the door of one political party but is the responsibility of the whole political class over the last 30 years. That point was eloquently made by the noble Baroness, Lady Grender, and my noble friend Lady Bloomfield. I also join other Members in congratulating the noble Baroness, Lady Osamor, on her maiden speech.
It seems that the Government are beginning to get their teeth into this challenge that society faces: first, by their commitment to commit £1.2 billion to  homelessness reduction; secondly, by the undertaking to back local councils to build more social homes; and, above all, by removing the borrowing cap from them. They have also committed, I think, £2 billion to housing associations. I would be very interested, as I am sure that the whole House would be, if my noble friend the Minister, in summing up the debate, could give us some indication of whether these policies are moving in the right direction.
I will ask my noble friend two questions. First, I think he was quite active in something called the rough sleeping initiative in the early 1990s. Rough sleeping is one of those ghastly things that brings home to us all the challenge we face in social housing. Has his experience in that area given him ideas and initiatives that will make it rather more hopeful this time round that we will begin to tackle this very serious problem?
Lastly, when we compare not just the city of London but major cities right across this country with major cities in other countries, one contrast that comes home is the fact that in the United Kingdom we have rows and rows of terraced houses, whereas most major cities abroad have blocks of apartments. My understanding is that the cost of housing in a block of apartments is better than in individual terraced housing. If we were able to divert some of our efforts into that area, it would also relieve some of the pressure that the green belt is facing. I would be very interested to hear my noble friend’s comments on that.

Lord Bassam of Brighton: My Lords, I join in the general congratulations to my noble friend Lord Whitty on instigating this debate on a subject which is of great importance to our nation, facing as it does a major housing crisis. I also join in the congratulations to my noble friend Lady Osamor on her fine and feisty speech in the cause of social justice.
Back in 1987, I became Labour’s first chair of Brighton’s housing committee, and as such I had a caseload of sometimes epic proportions covering housing repairs, rents, private landlord complaints and inquiries by homeless families. One of those who contacted me was a young single woman, with a small child, who was living in a room in a bed and breakfast just off Brighton’s seafront. The room was not much bigger than her single bed and had barely enough space for a cot and a few belongings. It was heated by an electric fan that consumed most of her income. The room was damp, miserable and depressing. The poor young mother asked if I could get her rehoused and I said that I would try, and that I could at least ensure she got more active consideration. I took a full note of her circumstances and made a description of the conditions in the appalling bed and breakfast. I then wrote to the housing manager, setting out her case and ensuring that she got active consideration for a new home. Not long after, she was allocated a flat, and she sent me a very kind note thanking me for my assistance.
Just after the 2010 general election, I received a slightly mysterious email from someone who said that I had helped them in the past. They wanted to update me and seek my advice. The email’s author asked to  see me and said that she would bring someone along with her. I made an appointment and when they arrived, I realised that we had met before; the young woman looked familiar but it was actually her mother who I had met over 20 years before. The young woman was the daughter in the small cot, aged four months; now, aged 23, she had not long since got a first-class degree and her first job. Her mum said that she simply wanted to meet me to say thanks, not just for my help all those years before but because that simple act had, in her view, turned her life around. It had given her hope and a home, and led to her daughter’s success in life—a heart-warming story.
It is for reasons like this that I believe in not just social housing but council housing. I grew up on a council estate and I am proud of that fact, but since I left those homes have been privatised and the stock of council housing nationally run down, as we have heard. Right to buy has turned into one of the biggest housing swindles of all time, with housing once owned collectively now owned purely for profit. In Brighton, 50% of our council houses sold through right to buy are now owned by private landlords, and we have the obscenity of the council having to rent them back from those private landlords to house homeless families. That is madness.
In 1980, 30% of our stock was publicly owned; now, the figure is 17%. Council housing starts last year were just 6,000, while housing associations managed 35,000. But as we have heard from the National Housing Federation, we need at least 145,000 affordable homes. Government policy focuses exclusively on home ownership. I believe in home ownership but not at the expense of all else. Margaret Thatcher’s dream of a property-owning democracy is exactly that—a dream. We have to get real and channel our investment where it works, and works fastest.
As housing chair in a local authority, I could summon up the land, pave the way for planning permission and build the homes. That was the reason why, even in the late 1980s, Brighton built 400 new homes a year. We could set targets for construction and we could meet them. It is why the single mother living in a bed and breakfast had a reasonable expectation that the council could help, and why she and her small family were able to thrive and grow, while having the reasonable expectation of, and aspirations for, a good life. We need to return to that dream and find ways to make it a reality. Council housing is, in my view, the route to that end.

Lord Greaves: My Lords, I remind the House that I am a district councillor in Lancashire, and I too used to be chairman of the housing committee. I agree with every word that the noble Lord, Lord Whitty, said, and am absolutely sure I would have agreed with every word he would have said in his last four minutes.
For all the faults of local authorities over the years and some of the major mistakes that were made, council housing is one of the great success stories of the last century. The more that that is said, the better. I remember when social housing was a new term introduced from America and we did not like it, because in America it meant housing for the down and outs and  people at the bottom of the pile. The problem, as some people have said, is that that is what it is turning into in many places in this country. Council housing at its best was housing run by and provided by the local community for the local community. It provided so many families with a decent quality of life.
The same was true of local housing associations when they started. They were set up as locally controlled and relatively small, providing for local needs. Nowadays, a lot of housing associations have simply turned into large non-profit-making housing companies. Why it is thought that affordable and social housing should be provided by companies like this, rather than by democratically elected local authorities, is a mystery to me. Yet many local authorities, including my own I regret to say, were bribed and bullied—by the Labour Government in our case—into a stock transfer to a housing association. We were bribed because of the vast amount of money the Government gave us. Some of it was for housing improvement, renovation and repairs, which was fine, but a lot of it was just money handed out to the council to bribe us to do it. We were bullied into doing it because, if we did not, we would not even get the money to repair the housing. Initially, it was okay, and it was a local housing association with local representation, but it has now become part of a large north of England housing company.
There are two major scandals associated with this. One is the fact that something like two out of five houses—probably more now—sold under right to buy are owned by private landlords. This is not a property-owning democracy where people own their houses under owner-occupation. It is simply a policy of the Tories handing over all this stuff to their mates and to private landlords. I have mates who are private landlords, and there are lots of good ones. But the large private landlord companies, particularly in the big cities, are responsible for a shocking deterioration in the housing stock occupied by the poorest people.
I do not have time to discuss the second scandal, the question of land, but it was referred to by the noble Baroness, Lady Bloomfield, and the noble Lord, Lord Best. Until the question of land is sorted out—in the cost of a new house in London and the south-east, something like 70% or more of that is for land; it is payment for nothing other than the uplift to the people who own the land—it will remain an absolute disgrace. The land ought to belong to the people. It does not, but we need some policies that move in that direction.

Lord Beecham: My Lords, I refer to my local government interests and join others in congratulating my noble friend on her maiden speech. The housing problem is not just a question of numbers, although that looms large. It is also a question of what we build, especially in the private sector, where space and energy standards lag badly behind those in much of Europe. It is also a question of tenure. Of course it is right to promote owner-occupation, but there is something terribly wrong with a system in which councils are compelled to sell council houses to tenants at knockdown prices—40% of which end up in the hands of private landlords, who then charge significantly higher rents.  Latterly, councils have been unable even to retain the proceeds of sale and use them to build new houses, while delivering £3.5 billion in discounts to tenants purchasing their homes.
Moreover, the Government’s interpretation of affordability in their promotion of new building is unrealistic, pitched at 80% of the values prevailing in a market inflated by the lack of new building. In addition, there is the problem of the bedroom tax, which forces up the rents payable by council tenants occupying properties larger than they are deemed to need. How many of us would wish to see elderly friends or relatives, or ourselves, induced in this way to move to smaller accommodation, possibly in a different area, or pay higher rents for the privilege of remaining in the home that one has occupied for many years, with all its accumulated memories? Three thousand and fifty-six Newcastle households were affected by this last year.
Homelessness is another product of the lack of a serious housing policy. It has increased nationally by 400% due to the loss of private rented tenancies since 2010, with rough sleeping up by 169%. Yet the National Audit Office reports a reduction of 21% in housing services and of 59% in Supporting People funding, while there has been a 60% increase in the number of households in temporary accommodation, with all the problems that causes, especially to children and the elderly. In Newcastle, these figures translate to the following facts: 40,000 residents affected by welfare reforms could risk homelessness, 18% of debt advice clients last year had unsustainable budgets and council house rent arrears last March stood at £3.6 million. The council helped 19,000 people last year to secure £30 million of unclaimed benefits and 6,500 received debt advice. Sadly, 254 people were found sleeping rough in Newcastle in 2017-18; 80% of them had drug addiction issues, 55% had mental health problems, 25% had learning disabilities and 25% had been in care.
This is not just a housing problem, although housing is clearly an issue. Like many others, the council has a goal of being a homelessness-free city. That requires support from central government, its agencies and the NHS. We need action and funding to achieve this goal in housing provision and other services.

Baroness Watkins of Tavistock: My Lords, I thank the noble Lord Whitty, for tabling and introducing this important debate. I concur with what he said and the Shelter report. I draw attention to my interests, particularly as a board member of a housing association, and join other noble Lords in congratulating the noble Baroness, Lady Osamor, on her humbling maiden speech.
In the excellent Library briefing on the topic, we are reminded that the number of socially rented homes has been falling consistently in England since the 1980s and that in 2016 only 17% of homes fell into this category, compared to 25% in 1981. At the same time, the number of households in privately rented accommodation has risen and statistics show that private renters spend a much higher proportion of their incomes on rent than social renters. Renters in London, particularly those in younger age group—between 25 and 34—are facing increasing housing costs. This affects in particular  key workers in the public sector, who need to be near to hospitals, schools, ambulance centres and other places in which they serve. Crisis argues that insecure tenancies in the private sector have led to an increase in the cases of homelessness and the placing of some young families in bed and breakfast. At the weekend, I looked on the Mayor of London’s website for a socially rented home with two bedrooms in south London. None is available.
The Government acknowledge these issues and in 2017 committed with local councils to build more social homes, as outlined in last year’s Green Paper. The Government say that they will promote ambitious new pro-development deals to build more social housing, yet a quick review of flats for sale in London at reasonable prices—between £150,000 and £500,000—revealed 18,000 properties, some of which were doubtless sold under right to buy. Many such properties are being sold by older people who wish to sell and move to smaller properties, often outside the metropolis, or by families who want to leave London. Could not a government capital scheme be devised to encourage housing associations and councils to buy back many of those homes, possibly at a slightly discounted rate of, let us say, 90% of the estimated value, and refurbish them quickly to house many of those families in desperate need of two or three-bedroomed social rent properties? Housing associations could carry out this regeneration quite quickly while still undertaking to build new homes, including smaller units for people whose families now live independently and are themselves ready to downsize.
While I have used housing in London as an example, it is equally important to consider how redundant stock in rural communities, or stock that has been for sale for a long period without being purchased, could be redistributed as social housing if a capital scheme enabled councils and housing associations to buy back properties. This would be particularly useful in expensive housing areas such as rural villages in Devon and Cornwall, where holiday home ownership has sent property prices soaring. I would welcome the Minister’s response on this matter, as it could provide a catalyst for increasing provision in tandem with the provision of new-build homes.

Baroness Blackstone: My Lords, I declare an interest as the chair of the Orbit group, a large housing association. Few areas of public policy are more pressing than the crisis in the supply of social housing. There has been a terrible failure by successive Governments to address it. Since 2010, the situation has worsened. Both the coalition and Conservative Governments have not taken it seriously enough. Recently, there have been some welcome changes in policy, but they should have been introduced much earlier and they are not nearly ambitious enough.
Decent housing is vital to the quality of life of our citizens, which is greatly damaged if their homes are damp, cold, squalid and overcrowded. It is disgraceful that many children grow up in such homes. The experience will often damage them permanently, denying them the ability to reach their potential at school or beyond.  Government investment in social housing should be seen as an investment in well-being and better economic outcomes.
It is also shocking that in a country as rich as the UK there are so many homeless people. The shortage of social housing means that local authorities struggle to meet their statutory duty to provide homes for people sleeping on the streets.
I want to make four points about the Government’s policies. First, the decision to raise the cap on local authority borrowing is welcome, but it is not sufficient. Why not allow local authorities to keep 100% of the receipts from sales to invest in new homes? I hope that the Minister will reply to that. Secondly, why not curtail the right to buy altogether, as has happened in Scotland? We have heard today the figures on the outcome from right to buy. Thirdly, new government grants to both local authorities and housing associations need to be very much higher if the supply of new social housing is to meet the agreed targets. The reduction in the shedloads of money going on housing benefit would in the longer term outweigh the extra investment via government grants—I am sure that the Minister will agree with that.
Finally, as others have said, the availability of land is vital. As my noble friend Lady Warwick implied, the Government need to reform the Land Compensation Act 1961 so that a fairer proportion of the rise in land value is shared in the community. Will they produce a transparent database of land ownership, including that owned by government departments or their agencies, with a view to enforcing the sale of some of that government land for new housebuilding, especially for social housing?

Lord Morris of Handsworth: My Lords, for the record I will take the opportunity to congratulate my noble friend on her maiden speech. She has much to offer your Lordships’ House. I also thank my noble friend Lord Whitty for securing this able and timely report.
It is timely for a number of reasons, but I shall draw to the attention of the House the report from Shelter that tells us that more than 250,000 people are now homeless in England on any given night. Many are in temporary accommodation or are sofa-surfing, as it is candidly put. More than 4,000 people are sleeping rough.
In 1967 the first English housing survey was published. Some 50 years later, the Department for Communities and Local Government reported that the social rented sector was down 30% from its target. In response to the post-war housing need, local authorities and housing associations built nearly 4.5 million social homes at an average rate of more than 126,000 a year. That figure stands as a challenge, but in 1980 local authorities’ ability to build and manage social housing was restricted. That year, just over 94,000 social homes were built. Three years later, supply had halved. Last year, it was down to a shameful 6,463 homes. That is an indictment of the nation and of decision makers.
Instead of spending on building social housing, the Government are spending billions of pounds on housing benefit, much of which goes to private landlords. There is no return on that sort of public spending. Councils are now spending more than £996 million a year on  temporary accommodation—a rise of 71% in the last five years. Those figures tell us that the problem is getting progressively worse. The effects of bad housing do not stop at the doorstep. It increases costs to the National Health Service and to education, and much more.
I commend Shelter’s housing commissioners, who have called in support and professionalism to make an assessment of the scale of the problem as they see it. They are seeking to recapture the original purpose of social housing, and I am sure that this debate will energise their efforts. I am also sure that noble Lords taking part in this debate will look to see what precisely Shelter will produce, so that we can take the benefits of this debate and integrate them as practical policy promotions.
I conclude by paraphrasing the President of Harvard University: “If you think solving the housing problem is expensive, try the cost of homelessness”.

Lord Fraser of Corriegarth: My Lords, I welcome the noble Baroness, Lady Osamor, to this House, and wish her a long and happy sojourn here.
I have arrived at this issue as a relative newcomer, and now realise how fiendishly complicated it is. To state the obvious, the final objective of social housing policy is to reduce, and eventually abolish, the terrible scourge of homelessness. This requires the provision of enough housing to give everyone a roof over their head.
However, the path towards this nirvana is not straightforward. Simply building hundreds of thousands of houses all over the country is not feasible. Who will pay? The local taxpayer or the central authorities? What happens if local inhabitants object? What happens if building houses conflicts with other objectives, such as protecting wildlife or rural amenities?
Various schemes have been adopted. Council tenants have been encouraged to buy their own house, liberating cash that can be recycled into building new homes. Builders of commercial or free-market housing estates have been told to earmark a proportion to be sold cheaply to provide social housing.
Housing associations and non-profit organisations have also been very active. Families have even been parked in hotels and hostels. None of this completely solves the problem. In areas near this House there are at least three such hostels—but of course they only provide temporary accommodation.
In practice, a buoyant economy has meant that house prices have risen and rents have gone up, but the money available from the state has remained static. This is particularly true in London and the south-east. As an aside, social housing in London and in the south-east typically comprises 30% to 40% of any new houses built. In other areas, where social housing is often more needed, the total may be between 15% and 20%.
There is a paradox here. While the softening of house prices in London has helped the aspirational, just-managing classes, those dependent on social housing have suffered. This occurs because the profit margin on free-market housing estates has fallen, allowing less for the social sector.
The private sector does not have much incentive to understand or deal with poverty. It regards this as the domain of the local authorities. While universal credit  could respond to this challenge, there are the issues of the first five weeks of the scheme before a payment arrives, and of the regulation that payment will normally go to the individual tenant, rather than direct to the landlord—a disincentive to the private sector.
Help, however, is at hand. Tackling homelessness has become a government priority. This has taken several forms. First, planning regulations have been simplified and, perhaps more importantly, enforced; secondly, the cap on local authority borrowing—as many have mentioned—is being lifted; and, thirdly, technology has become increasingly involved. The proper technology is available, which can map, price and plan for the outbreak of poverty and its consequences. Administrative data, which is beginning to bear down on these issues, both in the private and in the public sector, can now prevent rather than cure the problem—and, as we all know, prevention is better than cure.
The combination of the high priority put by the Government on the abolition of homelessness and the increasing role of technology can and should improve the productivity of the sector and, naturally, the lives of those affected.

Baroness Healy of Primrose Hill: My Lords, I congratulate my noble friend Lord Whitty on securing this debate, and my noble friend on her moving maiden speech.
I wish to raise one group in society that is often overlooked in debates on housing and homelessness—the elderly. By 2040, as many as one-third of all 60 year-olds could be renting privately, facing unaffordable rent increases or eviction at any point. They could be living with insecurity and in poor accommodation, with increasing numbers relying on housing benefit.
The elderly should have the right to a safe, secure and comfortable home, especially when they may be ill, disabled and less resilient. The charity Age UK has highlighted concerns about the 1.9 million pensioners in the UK living in relative poverty, 36% of whom are private tenants. It wants to see laws to improve the take-up and availability of the disabled facilities grant—only 7% goes to the private rented sector. Security of tenure needs to be extended to five years so that private tenants can access these grants.
The private rental sector cannot meet the needs of vulnerable elderly people, many of whom live in terrible housing conditions that affect their health and well-being. Lack of security of tenure prevents them accessing repairs, improvements and adaptions because of a fear of losing a tenancy or being subject to unfair or abusive behaviour.
Only by providing more social housing of good quality and affordability can we help keep older people healthy and living independently, and reduce the need for residential care. We need consistent standards for all sheltered and extra-care housing in the social rented sector, and all new build should comply with the lifetime homes standard so that the need for adaptation is lessened as tenants age.
Homelessness among the old is also on the increase, rising by 40% in the last five years. The Centre for Policy on Ageing estimates that in England on any one night, around 400 older people aged 55 and above may  be sleeping rough. Age UK is concerned by some local authorities’ reliance on the private sector to meet their duties under the new Homelessness Reduction Act by offering financial help to access housing, resulting in people who lose one insecure private tenancy being helped to find yet another insecure private tenancy. There must be more affordable options in the social rented sector.
Shelter’s commission is correct in calling on the Government to invest in a major 20-year social house- building programme, culminating in 3.1 million new social homes. Labour is committed to a major council house-building programme. We must as a country meet the challenge and create a new generation of housing equipped to meet the needs of an ageing society.

Lord Judd: My Lords, I too thank my noble friend Lord Whitty for introducing this debate. Its quality so far shows how right he was to choose this subject. I also thank most warmly my noble friend Lady Osamor for a powerful and moving speech. I believe she has a great deal to offer this House in the future.
I want to make a plea: I hope that in our concern about housing we do not underestimate the significance of the rural housing crisis. The sale of council houses and the subsequent profiteering is an indication of the difficulties and challenges, but also an indication of how misguided a policy can be. I would like to put to the Minister a specific question on the part being played by the Land Compensation Act 1961 in England. It has obviously gone wrong, and it seems that unless we tackle the ground it covers, we will be in difficulties with whatever housing programme we want.
My experience in politics says that what matters most in all this is the political will to do it, which means not just one Minister but all the interrelated Ministers. We have the problems of health, mental health, poverty and acute unhappiness in old age. All are related to housing, and unless we get everybody behind this and a determination that we are going to do it, it will not get done.
In particular, I thank the right reverend Prelate the Bishop of Chelmsford for his terrific speech. He reminded us that a house is not just a house but a home. That means that in our programme and determination, we must think of the social issues, integration with health and schools, the police and the probation services—all these things—so that we make an integrated society where people are not stigmatised but part of the community, and so that we enable people to live rich lives.

Lord Thurlow: I too add my congratulations to the noble Lord, Lord Whitty, on securing this debate; the number of speakers, balanced across all sides of the House, is testament to the severity of the subject being considered. I of course congratulate the noble Baroness, Lady Osamor, on her maiden speech, which was powerful and quite emotional. I declare my interest as a small-time landlord, as declared in the register.
This debate is about stark facts. We have heard shocking statistics repeated in several speeches. I will not add to the facts, but they are pretty shocking. There is the number of council houses sold; the lamentable  replacement numbers; the affordability of the housing constructed; the rental cost discrepancy between affordable housing, as deals are done with private developers, and council or social housing; waiting lists—here I will add a statistic: Shelter told us that over 1 million households were on waiting lists in 2017; and homelessness. The noble Lord, Lord Morris, made an inspired comment about the cost of homelessness, which is huge. These are all stark facts. While it may be difficult to add to the statistics, this is a take note debate. I hope that the Minister will indeed take note of these shaming numbers coming from all sides of the House.
I think we all agree that there is no quick fix. We need a cohesive strategy and a long-term programme, and we need to reflect regional differences and needs. Perhaps we also need to replace the emphasis on, or reconsider, the right to buy. I have not heard references to the staircasing shared ownership programme, which has been around for many years. It allows the owner of social housing to buy a small percentage of the equity in their property, perhaps 20%—something they can afford. They do not need a big mortgage but something that they can manage, at market value, and when they are ready and if they wish, they can buy some more at the current market value. That should be looked at more carefully. New borrowing powers for local authorities will take time to mature; there is no quick fix.
On cost, clean sites are expensive. The noble Lord, Lord Best, an acknowledged authority, has referred to an interesting proposal to reduce the costs, but why not try harder with brownfield land? It is frequently serviced and centrally located, with good access to transport, hospitals, schools and shops. It needs cleaning up, so get on with it—clean it up anyway. Much of it is in indirect government ownership. It is morally unjustifiable to develop green space, particularly greenfield space, when this is the case.
My three minutes are nearly up. Steadily selling stock without replacement is a spiral—a sure way to make the problem worse. The population is not declining. I have two questions for the Minister. Why are sales not being replaced, and why is there so little funding for local authorities?

Lord Sawyer: My Lords, I also thank my noble friend Lord Whitty for organising this debate and my noble friend Lady Osamor for her excellent maiden speech; no doubt there are many more to come, especially if she sits next to this fellow—he can teach her a trick or two. I also thank my noble friend Lady Lawrence for being a member of the Shelter commission. Its report is one of the best on housing I have ever read, and this could be a watershed moment if Ministers are prepared to read it and put it into effect. That is a big if, but it is a great report, so well done. It lifted my spirits to come and speak in this debate, because they were not high today.
We are getting towards the last speaker, and, let me tell you, when you are the last speaker you listen carefully to all the debate—more so than if you are the first speaker and you pop out to the loo. But I have the weight of this debate. There have been some outstanding speeches, and I started to write them down. I thought,  “I’m going to write down all the great speeches”, but the list was too long—there have been some great speeches from all sides.
What is the story? I am sorry to say that it is a story of pain, misery and unhappiness, to echo the point made by the noble Lord, Lord Thurlow. Homelessness, drug addiction, mental health issues, insecure tenancies, dreadful private landlords—dear me. What a mess we have got ourselves into, and what are we going to do to get ourselves out? It is a shocking state of affairs that I have sat and listened to this afternoon. I can tell your Lordships that if I was the Minister, I would go back to No. 10 and kick some backsides to get something done about this.
What about us? We are not doing too badly. I hope we all live in the homes of our choice, in warm and safe homes, exactly as we like to live, and that whether we own them or rent them, we are all okay. We are like the majority of people in this nation, and that is how the majority should be. That is how everybody should be, not just a majority: able to live in their home of choice—a warm, secure place. The gap between those people we talk about in our debate and us is enormous. It is like two different planets, and we must do something about it—close it down, tackle it and put it right—because it is a shame on our nation.
My noble friend Lord Beecham mentioned Newcastle, which is a great place. I say in passing: Man City 1, Newcastle United 2. if you can believe that, you will believe anything, but it is true. He said that Newcastle had a policy of a homelessness-free city. I hope that the Minister will say this afternoon that it is the ambition of the Government to have a homelessness-free nation.

Baroness Donaghy: My Lords, I thank my noble friend Lord Whitty for initiating this debate and congratulate my noble friend Lady Osamor on her wonderful maiden speech.
Shelter’s report recommends a political consensus on social housing. Perhaps we could just agree to adopt it and its recommendations, and then we can all go home. As someone brought up on a council estate, and who was horrified by the right-to-buy policy in the 1980s, with the loss of 3 million homes from the social housing stock, any political consensus cannot come soon enough. I was part of the generations for whom, as Shelter describes,
“social housing played a vital role in meeting the housing needs of ordinary people”.
It was not an ambulance service. The aim of the report is to recapture this purpose. The explosion in the private rented sector has led to seemingly contradictory outcomes: an increase in housing benefit costs and an increase in homelessness. Capital Economics has stated:
“Over the past decade this rising proportion of housing benefit caseloads in the private rented sector has cost nearly £14 billion in additional benefits and rental payments in real terms”.
Turning to private renting, which has doubled since 1997 and comprises 20% of all households in England, more than a quarter of such properties fail to meet basic standards. The Minister will be aware of the selective licensing scheme, under which all privately  rented properties must be licensed with the local authority. The Chartered Institute of Environmental Health and the Chartered Institute of Housing have published a joint report entitled A Licence to Rent, looking into the effectiveness of such schemes. It finds that in areas with selective licensing,
“high numbers of serious hazards and defects”,
are “being identified and addressed” as a result of property inspections. I understand that the Government are conducting a review of selective licensing, and I hope the Minister will be able to tell us how that is progressing and whether the Government will consider the recommendations of the two chartered institutes’ report, including setting up a national landlord register in England.
Finally, the National Housing Federation and Crisis have produced a report that shows that our housing backlog has reached 4 million. They have called on the Government to make ambitious, comprehensive reforms to the land market, including prioritising the sale of public land for social housing. What plans do the Government have to tackle the land market issue?

Lord Shipley: My Lords, I remind the House that I am a vice-president of the Local Government Association. First, I congratulate the noble Baroness, Lady Osamor, on her excellent maiden speech, which was rooted in a strong sense of public service and community. It is a delight to see her take her place in your Lordships’ House. I also thank the noble Lord, Lord Whitty, for enabling us to have this debate. As my noble friend Lord Greaves said, there was nothing to disagree with in what he said. He drew attention to the excellent report from Shelter and he called for drastic and strategic action in his detailed analysis of the reasons why we need many more homes for social rent over the long term—two very important words.
As my noble friend Lady Grender said, all parties have failed over the past 30 years and we must start to work together. I entirely agreed when she said that the Treasury needs to be held to account in the spending review for investing in revenue subsidy through housing benefit at the cost of investing in social housing as part of our capital infrastructure.
The evidence given in support of the Motion has been there for all to hear in today’s debate. Despite a stream of government announcements over the past two to three years that they would act to solve the housing crisis, in practice, very little has been done to achieve it. The long-awaited Green Paper on social housing remains just a Green Paper.
The result is that today we have 320,000 people sleeping rough or living in temporary accommodation, which is a rise of 13,000 on the previous year. Local councils have to meet a bill of just under £1 billion to pay each year for temporary accommodation, and the social housing waiting list amounts to more than 1 million households. We have a private rented sector which now accommodates one household in five across the United Kingdom, up 50% in the past 10 years. As we have heard, we have a housing benefit bill that has risen to £21 billion today and, as I said, about which the Treasury seems to show little concern, when it  could turn that current expenditure into capital infrastructure spending. Crucially, three times as many social homes have been sold in recent years as have been built.
In October, I led a debate in this House on affordable housing—that is, housing that is genuinely affordable. As I said then, the cost of home ownership can never be met by very large numbers of people. Average home prices are eight times annual workplace earnings; 20 years ago, the figure was just three and a half times. Private renters are now on average spending 41% of their income on housing, so saving becomes very difficult for them. Those figures come from the latest English Housing Survey.
The Government’s White Paper published in February 2017, called Fixing Our Broken Housing Market, stated:
“The starting point is to build more homes”.
Perhaps the Minister will note those words: it is about building more homes, not simply converting other dwellings outside the usual planning system, without the appropriate number of affordable homes being included, let alone social homes.
My noble friend Lady Thornhill pointed out the imbalance between government subsidy for owner occupation and for rent. As she said, the removal of the housing cap will help, but we cannot just leave it to local authorities. They need considerable subsidy and a real plan of action. They need the right to limit the right to buy, including the right to keep 100% of receipts from sales. There must be a debate about that issue because, as has been said, there is a real danger that local councils are simply being set up to fail.
The Chartered Institute of Housing, in a report in November 2018, said that £8 billion of government support is going into the private housing sector up to 2021, with half going into private owner occupation over that period, when social housing support is less than £2 billion a year. Two billion pounds is the sum of money that London-listed housebuilders declared as dividends in 2018. It is broadly the same sum as was spent by the Government to support social homes. I hope that noble Lords on all sides of the House will find themselves very concerned by those figures.
Help to Buy has finally been changed to assist only first-time buyers. As reports have shown, Help to Buy has encouraged higher house prices. A 2017 report from JP Morgan showed that it has led to higher profits, higher share prices, higher dividends and higher bonuses for builders. I note that the noble Lord, Lord Fraser of Corriegarth, asked who would pay for this. I think that the answer lies in the debate we need to have about the balance between government subsidy of private housing and owner occupation and the cost of public housing and social housing. We should recognise that, in recent years, public money has been spent on subsidising owner occupation at the expense of building social homes for rent. Surely the time has come to redress that balance.
My noble friend Lord Greaves reminded us that council housing is one of the great success stories of the past century: locally provided for local people. He also reminded us of the originations of housing associations, which were similarly local. I agree with him: we must go back to greater local accountability  in the provision of affordable housing. Mention has been made in the debate of the uplift in land value caused by planning permissions. Across all parties, there is huge concern about this matter; I hope that the Minister will be in a position to say something further on that. I am convinced that the Land Compensation Act 1961 must be amended, as the noble Lord, Lord Best, reminded us.
Now that the Shelter report is out, many other reports are out, all saying the same thing. We need a debate about the kind of social housing we want to build. It needs to be accessible. We need lifetime homes and decent space standards. We need to know where the social housing will go because different numbers are required in different parts of the country. Above all, we need an action plan for delivering solutions to the problem that has been identified so clearly. We need to think about key workers. We need to work out ways to reduce the high housing costs faced by so many people. We need a means to get young people on to the housing ladder. In saying that, I believe that we need a new generation of homes for social rent for those who need help with housing, such as key workers and those on low incomes, and for those for whom renting is a step on the ladder and who aspire to own their own home. I was very struck by the contribution of the noble Lord, Lord Bird, who said that this should be about not just social housing but sociable housing. I concur.
In October, I said that our current housing crisis represents the biggest failure of public policy in the past 20 years. Today’s debate has shown that to be true. We have built more than 2 million too few homes across the UK, resulting in high prices, high rents, fewer social homes and serious difficulties for younger people wanting to buy their own home. One in five households is now in the private rented sector, where conditions can be very poor and tenure insecure. We have an imbalance and a major problem to solve. It is the duty of any Government to solve that problem.

Lord Kennedy of Southwark: My Lords, I thank and congratulate my noble friend Lord Whitty on securing the debate. I draw the attention of the House to my relevant registered interest as a vice-president of the Local Government Association. I congratulate my noble friend Lady Osamor on her excellent maiden speech; I look forward to hearing from her many more times. She brings a wealth of experience to our debates, as we heard today, and I am delighted to welcome her.
We all accept, I think, that we are in the middle of a housing crisis. Today’s debate is focused on the part of the housing crisis in which we see people in the most desperate need imaginable. You would have hoped that the Government would have focused their primary policy action there, but that is not the case and this failure is paid for by the taxpayer through increased housing benefit bills and other costs.
The Government understand that there is a problem. I accept entirely that successive Governments have not done as much as they should have. However, we have a crisis and despite all the evidence before them, the  Government cannot bring themselves to take measures that would make a real difference to help those in the most desperate need and, at the same time, reduce costs and make housing more affordable for all, across all tenures. They are caught up in starter homes, pushing more right to buy with no programme for the replacement of the social homes lost, and the ridiculously named “affordable rent” model, which is totally unaffordable for many people. The result is a booming housing benefit bill and an increasing private rented sector with no real support for local authorities to deal with the rogues that operate at the bad end of the market; I am well aware that many excellent private landlords also want the rogues dealt with.
We need to hear more from the Government on a real commitment to building more social homes on proper social rents: a commitment that also involves housing associations being enabled to do the same and being encouraged to live up to and return to their founding principles—a commitment to make housing costs cheaper for everyone, whatever the tenure. The noble Baroness, Lady Bloomfield of Hinton Waldrist, raised the issue of community trusts and offsite-manufactured housing. I agree with her that such initiatives can make an important contribution to housing needs. I also think that the co-operative sector could play a much bigger role in an expanded sector, providing much-needed social homes where tenants have direct and real control over their homes.
The Prime Minister deserves credit for dropping—certainly quietly forgetting about—some of the worst provisions of the dreaded Housing and Planning Act, which must be a contender for one of the worst pieces of legislation. Written on the back of a cigarette packet, it was the biggest piece of ideological rubbish brought forward by the Government in recent years. We will all be better off for a commitment from the Government. I just do not understand why the Government are so reluctant to do more of what could make a real difference. To be fair, the Government have taken a positive step with the lifting of the borrowing cap to enable councils to build more homes. I congratulate them for that, but we need local authorities to be able to keep 100% of the receipts for council homes sold under right to buy. The Government should at least do that, if they are not going to suspend right to buy, as has happened in Scotland and Wales.
I want to see a rise in home ownership but not a decline in the council homes available for rent. The noble Lord, Lord Greaves, was right to point out that the intent behind the right to buy policy was probably to increase home ownership, but 40 years on many of those homes have found their way into the private rented sector and, in an act of madness, councils are having to rent back the homes they sold in the first place at vastly increased prices. It is a matter of regret for us all.
As I have told the House before, like my noble friends Lord Bassam and Lady Donaghy, I grew up in council properties; in my case, in the Borough of Southwark, on the Aylesbury and Pelier estates, which are very close to where the noble Lord, Lord Hayward—he is on his place on the Government Benches—now lives. The properties I lived in as a child were warm,  safe and dry; they were good for our family and helped us to thrive, as the noble Lord, Lord Porter, made reference to in his speech.
The noble Lord, Lord Bird, was absolutely right when he described council housing in the 1960s and 1970s, and my own experience was very similar. We had teachers, office workers, young families, retired people and unemployed people all living together. That is not the situation now on many of our council estates. Moving forward to today, I and all my siblings are home owners and we recognise how lucky we were as children to have a decent home to live in. My noble friend Lord Sawyer was right to say that the story now is often one of pain, misery and suffering. I think that life is very tough for people with young families trying to make ends meet while paying the market rent for a private rented property or, as I have said, the unaffordable affordable rent model. The year before last, I actually wrote an article for the Fabian Society about how living in a council home had helped my family to thrive. At this point, I should mention that I serve on the executive committee of the society.
Looking at government statistics, we have new housing completions in 2017-18 reaching 163,000, a 16% increase on the previous year, but looking at the figures in detail, only 27,410 were built by housing associations and just 1,700 by local authorities. One must ask how many of those homes that were built in the social sector will be let at truly affordable rents. I fear not enough, even among the small number of homes being built.
The noble Lord, Lord Fraser of Corriegarth, made an interesting contribution, although I did not agree with very much of it. However, I agree with him that prevention is better than cure, but to deliver that we need to see more initiatives, policies and resources being targeted at prevention; otherwise, the taxpayer and society as a whole will pay many times over for this policy failure. We need to deal with the problem in the first place.
The removal of the borrowing cap is obviously welcome, but that on its own will produce around only an additional 9,000 homes each year, nowhere near the 100,000 social homes that I believe need to be built every year to deal with this problem. My noble friend Lady Warwick of Undercliffe made the point about the need for new social homes to be genuinely affordable. As I said earlier in my contribution, this is a really important point.
Can the noble Lord tell the House whether the Government will look at removing housing borrowing from contributing to public debt? What plans do they have for local authorities with no housing revenue account to enable them to access borrowing in order to build homes to meet local housing need? The noble Lord, Lord Thurlow, also made a good point about looking at making more use of brownfield sites. We need to do much more of that.
One of the most shocking things we have seen in recent years is the rising number of people who are homeless. The right reverend Prelate the Bishop of Chelmsford paid tribute to the work of churches and faith communities in supporting homeless people, and I join with him in paying my own tribute. Homelessness is of course in plain sight outside this Palace. My noble  friend Lady Warwick of Undercliffe told the House about the homeless person who last year died literally feet away from this House. I think that that is absolutely tragic. Indeed, you cannot walk from a mainline station to get to the Palace without seeing homeless people sitting in doorways through these bitterly cold nights. It is a shocking and shameful scandal that has grown substantially since 2010. Despite the Homelessness Reduction Act, unless we provide realistic money to local authorities to pay for interventions and thus deliver on their new obligations, what is a well-intentioned piece of legislation will not have the impact it could have to help towards solving the tragedy of homelessness.
I also think that housing policy and good intentions are often frustrated by the work of other departments and a lack of joined-up thinking across government. This is a trap that all Governments can fall into. I think that the actions of the Department for Work and Pensions need to be looked at carefully to see the damage that they are inflicting on other government programmes and initiatives. Can the noble Lord, Lord Young of Cookham, tell the House how the policy decisions and proposals are discussed across government in order to avoid these problems?
In conclusion, I thank my noble friend for bringing this Motion before us. It has been an excellent debate with great contributions from across the House. We all want to solve this problem and we want to support the Government in doing that.

Lord Young of Cookham: My Lords, I am grateful to all noble Lords who have taken part in what has been a very constructive debate, as the noble Lord, Lord Kennedy, has just said. In particular I am grateful to the noble Lord, Lord Whitty, for choosing it and for introducing it with a very eloquent non rant.
It is almost 40 years since my first speech as a housing Minister in 1981. The noble Lord, Lord Whitty, was then working for the General, Municipal, Boilermakers and Allied Trades Union prior to running the Labour Party. The noble Lord, Lord Shipley, was a Newcastle city councillor keeping tabs on the noble Lord, Lord Beecham, who was entering his middle period as the leader, and a youthful noble Lord, Lord Kennedy, was waiting to be able to vote in his first general election. Affordable housing was a priority for the Government then and it remains a priority for the Government today.
It was during my time as a housing Minister in the 1980s that I met the noble Baroness, Lady Osamor. She was campaigning for the renovation of the Broadwater Farm estate and, as important, for the empowerment of the local community and an improvement in its relations with the local authority and with central government. I remember meeting community leaders, of whom she was one, and the charismatic Dolly Kiffin. It is good to renew her acquaintance after all those years. I commend her on her speech and look forward to her future contributions.
An occasional partisan note has crept into our debate. As noble Lords know, I am the least partisan of Ministers. Perhaps I may just put one or two statistics before your Lordships to redress the balance;  this debate is about social housing. Between 1997 and 2010, the stock of social housing fell by 420,000. Since 2010, the overall stock of social housing has increased by 79,000. Some 12,440 local authority dwellings were built between 2010-11 and 2017-18, up from 2,920 over the previous 13 years. The briefing we all got from the Home Builders Federation said that housing output was up by 78% in the last five years and that the supply has risen to its fourth highest level since 1971. For the year ending March 2018, the planning system granted permission for 359,000 new homes. There is more in my brief which I will not deploy because I want to answer the debate and because we are in no way complacent about the task ahead.
I would like to make two general points about social housing. First, there has been much emphasis on the need for more housing at social rents, a point made by the noble Lords, Lord Kennedy and Lord Shipley, as opposed to affordable rents. I understand the case, but there is a trade-off between rent levels on the one hand and the number of homes that can be built on the other. For the sake of argument, let us assume that an extra £1 billion became available. On average across England, we would expect either to build 12,500 homes at social rents or twice that number—25,000—at affordable rents: double the number of homes to house those in housing need. Moreover, approximately two-thirds of social housing tenants receive housing benefit to support the payment of their rent. So I understand why housing Ministers want to maximise supply, and I plead guilty to this. More recently, the Government have recognised the case for social rents in areas of high demand, a point made in this debate, and we have turned the dial back to provide a minimum of 12,500 new social rent homes. But those who call for a major reversion to traditional social rents must recognise the cost in lost output, and that is true whatever the level of investment available.
The second general point is one that has not been made at all in this debate: if you are in housing need, of course the number of new social homes built is relevant and the more the better. But someone in housing need is eight times more likely to be rehoused through a re-let of an existing social home, than through a new home. So increasing the number of re-lets is a key ingredient in helping those in need. Without changing the rules on security of tenure, I am all in favour of a dialogue between social landlords and their tenants where the tenants’ circumstances have improved substantially, partly as a result of having a decent home, so that they are now in a position to consider home ownership and explore help to buy, shared ownership, which was mentioned by the noble Lord, Lord Thurlow, and other home ownership options.
That is also why I have always been a keen supporter of portable discounts—basically, turning the discount that a social tenant is entitled to under right to buy into cash so that the tenant can buy a home. It has a number of benefits. It widens the choice of home that the tenant can buy beyond just the one he is in. It secures a re-let at a fraction of the cost of new build, and of course it does so more quickly. Moreover, it does not erode the stock of social houses, a point made by many noble Lords. The concept is being tested  through the current voluntary right-to-buy pilot for housing association tenants in the Midlands; the discounts are funded by central government. I hope housing associations consider whether this has a greater role to play in tackling waiting lists.
On this, and in response to points made by the noble Lord, Lord Whitty, I was interested to read in last week’s Inside Housing an article by Mark Henderson, the chief executive of Home Group, supporting voluntary right to buy. He said that 87% of his tenants wanted to own their own homes. He went on to say:
“At Home Group, for example, we want to go a step further”,
than the national federation’s offer of replacing one for one.
“We will be able to build two homes for every home sold, including at least one for social or affordable rent. This means that”,
voluntary right to buy,
“will lead to a net increase in the amount of affordable homes in an area, alongside helping customers achieve their aspirations of homeownership”.
I hope other housing associations might consider following his lead.
This brings me to right to buy and the points made by many of those who have spoken, including the noble Lord, Lord Whitty, and the noble Baroness, Lady Blackstone, about the use of right-to-buy receipts. Since the reform of the housing revenue account and the introduction of self-financing in April 2012, a proportion of receipts is paid to the Treasury to reflect the reduction in the amount owed to the Treasury and as part of the self-financing settlement, but also to tackle the budget deficit. However, noble Lords will know that we have just undertaken a consultation on the use of right-to-buy receipts. We are considering the responses and how to take these forward. I will ensure that all the points made by noble Lords about more flexibility and the use of capital receipts are taken on board before we come to a final decision on that. Capital receipts could be used for the purposes the noble Baroness, Lady Watkins, suggested, namely, regenerating existing local housing stock. The noble Lord, Lord Kennedy, asked whether local authorities that have transferred their stock can borrow. Yes, they can. They can borrow through their general fund in line with the prudential code. If they want to, they can then on-loan to a third party for housing development.
I turn to rough sleeping, a topic covered by many noble Lords, including my noble friend Lord Garel-Jones, the noble Lord, Lord Pendry, the noble Baronesses, Lady Lawrence and Lady Warwick, and others. Many referred to the tragic death of a rough sleeper on our own doorstep a few weeks ago. Under the first rough sleepers initiative, which was launched in 1990 and which my noble friend Lord Garel-Jones mentioned, the number of people sleeping rough in central London fell by more than half—from an estimated more than 1,000 before the initiative began to around 420 in November 1992. The model was taken forward by the incoming Labour Government and extended to other parts of the country, but the challenge today is as acute as ever.
In response to my noble friend, there are four ingredients to a successful strategy. The first is prevention. The Homelessness Reduction Act, backed by £1.2 billion  and piloted through this House by the noble Lord, Lord Best, should give people the help they need earlier and reduce homelessness. Secondly, we need outreach workers with the skills to build up confidence and trust with the rough sleepers and persuade them to abandon that lifestyle. Thirdly, we need direct access hostels with all the necessary support services such as health—mentioned by the noble Baroness, Lady Lister—and the resources to deal with the underlying problems. Fourthly, we need move-on accommodation so that people can put their lives back together and re-enter the mainstream.
I join the right reverend Prelate the Bishop of Chelmsford in praising those who do heroic work: Centrepoint, The Passage, St Mungo’s and Change Grow Live. Initiatives such as No Second Night Out are particularly important and worthy of support. I pay tribute and wish every success to my ministerial colleague in the department, Heather Wheeler, committing to halve rough sleeping by 2022 and—in response to the question asked by the noble Lord, Lord Sawyer—end it completely by 2027. It is an ambitious agenda, backed up by £100 million in funding for the first two years, and in December we published a delivery plan showing how we intend to deliver on the 61 commitments made.
I am grateful to the noble Lord, Lord Bird, for his contribution outlining the consequences of ending rent control. When I bought my copy of the Big Issue today from Phil in Great Peter Street, he asked to be remembered to the noble Lord. Phil suggested that those in the Victoria area who are recruiting staff could do well to call in on the nearby hostel where Phil stays, where they would find some motivated and hard-working employees who deserve a break, like him.
Many noble Lords spoke about encouraging local authorities to build, and we want to see councils deliver a new generation of homes. We have abolished the housing revenue account cap, and my noble friend Lord Porter deserves credit for the role he has played in securing that freedom. We hope that will enable them to double delivery to around 10,000 homes per year by 2021-22.
The noble Lord, Lord Whitty, criticised stock transfer, when a local authority transfers its stock to a housing association. This can happen only where the tenants have voted for it. In many cases, after they voted for it, the regeneration of a stock took place at a faster rate than would have taken place under the local authority— so I do not think that is a fair criticism of housing policy.
Removing the borrowing cap will help to diversify the housebuilding market, with councils better able to take on projects and sites that private developers might consider too small. To further help councils build, we are providing a longer-term rent deal for five years from 2020 that provides local authorities with a stable investment environment to deliver the new homes.
I was struck by the phrase “long-term” in the noble Lord’s Motion—a challenge to all Administrations accused of short-termism. I agree with him that if we are to make faster progress we need to give those who supply social housing greater certainty. That is why in  September the Prime Minister announced a £2 billion long-term funding pilot, starting in 2022, which will boost affordable housing by giving housing associations the long-term certainty they need and will move away from the stop/start delivery that has characterised previous approaches to funding. This funding certainty makes it more viable for the larger housing associations—many noble Lords have key roles to play in housing associations—to take risks and invest in more ambitious projects and larger sites, with the funding guaranteed beyond the current spending review.
We recognise that our commitment to increase the supply of homes requires a modern construction industry—a point raised by my noble friend Lady Bloomfield, who talked about off-site construction. The strategic partnerships we are developing with housing associations are being used to promote modern methods of construction. This is supported by our £4.5 billion home building fund providing support to builders using modern methods of construction, which will, we hope, help to address the shortage of skilled on-site construction workers in addition to encouraging custom builders and new entrants to the market.
My noble friend Lord Garel-Jones suggested that we should build up rather than along and pointed to the difference between our cities and many in Europe. It so happens that yesterday the Secretary of State for Housing announced that, as part of a fresh initiative, 78 homes will be built on London’s rooftops by the summer after Homes England agreed a £9 million funding deal with Apex Airspace Development. This follows our revised NPPF supporting opportunities to use the airspace above existing buildings. These will be built off-site then winched into position to minimise disruption to existing residents.
Many noble Lords referred to poor standards in the private rented sector. The noble Baroness, Lady Donaghy, asked about selective licensing, which is basically a scheme to drive up standards and safety in the private rented sector, where they are known to be poor. Last year, at the invitation of the noble Lord, Lord Kennedy, I got up very early one morning and went to Newham with the noble Lord, the Mayor of Newham, Rokhsana Fiaz, and the police to see how selective licensing was enforced—basically, by going into premises that are as yet unlicensed but suspected of being tenanted. What struck me—and, I am sure, the noble Lord—was the appalling conditions many tenants were living in, paying extortionate rents, but also the sensitivity of the team from Newham in explaining to frightened tenants exactly what was going on and what their rights were. I was deeply impressed that morning.
Since 2015, eight schemes have been approved by the Secretary of State for Housing: one was rejected but it then successfully reapplied. In response to the noble Baroness, a review is under way: we are due to publish it in the spring and I will make sure that the chartered institute report to which she referred is fed into it before we come to any conclusions.
My noble friend Lady Bloomfield raised a number of important points on planning, investment and construction. Last year we updated the NPPF to tackle unaffordable house prices in many areas across the country. The framework sets out a new way for  councils to calculate the housing needs of their local communities. We are working closely with other government departments and local authorities to identify and free up public sector land to maximise the amount of affordable housing built on it. The community trust partnership mentioned by my noble friend is one model that can help bring private sector investment alongside local authorities and provide experience to increase affordable housing.
One of the key points that has arisen during the debate—which I will certainly raise with the Secretary of State—was the cost of land and the Land Compensation Act 1961. At the moment we have the CIL, the infrastructure levy, and Section 106, both of which seek to capture the value of land. Many noble Lords, including the noble Baroness, Lady Blackstone, and the noble Lords, Lord Shipley, Lord Best and Lord Judd, said that we ought to go further and do more. We are committed to capturing increases in land values to reinvest in local infrastructure, central services and further housing. That is why we are at the moment making important changes to ensure that the existing mechanisms for securing funding for infrastructure and affordable housing work as effectively as possible. I take seriously the comments and suggestions made during the debate.
I am conscious that I will not be able to get through everything in the time available but, quickly, on public sector land, an issue raised by the noble Baroness, Lady Warwick, the aim of the programme is to release land with a capacity for at least 160,000 homes in England from the central government estate by 1 March 2020. The noble Baroness asked what the percentage of affordable might be. The answer is, as I think she knows, that local authorities set their own percentages in their local plan. It is a matter for them, having assessed local need, to judge what should happen on new developments.
On supported housing, I was interested in the speech of the noble Baroness, Lady Healy. There is a need for specialist and other supportable, affordable housing for older and vulnerable members of society. We have delivered 34,000 new supported homes in England since 2011 and, together with the Department for Health and Social Care, we continue to make funding available for investment in new supported housing. Our announcement last summer that the housing costs for supported housing would continue to be made by housing benefit has been greatly reassuring to those active in the market. I hope it will be welcomed by the sector and unlock fresh investment.
I apologise for not dealing with all the questions. I have many good replies in front of me which, sadly, I do not have time to read out but which I will answer.
The Government support the case for delivering more affordable housing and are committed to doing so. We want to support the delivery of the right homes, be they for rent, ownership or supported housing in the right places. We have listened to the sector and to today’s debate. We have introduced a number of measures to create a more stable investment environment. We have abolished the HRA borrowing caps; announced longer-term funding; increased our affordable homes  programme to £9 billion; announced social rent funding; and set long-term rent certainty. We are not complacent but now is the time for councils and housing associations to step and deliver the affordable housing that communities need. I thank all noble Lords again for their contributions to this debate.

Lord Whitty: My Lords, I thank everyone who has taken part in this debate. I particularly appreciated the maiden speech of my noble friend Lady Osamor.
Until the Minister spoke, I was going to say that we have a wide consensus in this House. I know the Minister’s heart is with that consensus but he felt obliged to read out—unusually for him—large chunks of his report to defend the Government’s position. However, all Governments have failed on this front and we are faced with a colossal problem. We are in the midst of an enormous housing crisis in general and we will not get out of it without a substantial contribution from council housing.
Yes, that has to be afforded and directed towards the priority areas. The noble Lord, Lord Fraser, asked where the money was coming from. There is a huge amount of money effectively being wasted in housing benefit, which, over a 20-year strategy—if the Treasury was slightly more strategic and intelligent—we could begin to transfer back into building and improving the fabric of housing available to everyone.
I am grateful to all noble Lords who have spoken. The noble Lord, Lord Bird, reminded us that social housing has to be sociable and the right reverend Prelate said that this is all about community, which it is—absolutely. This is not only about individuals but about community. For social housing to meet the needs of people and to become a community, it must be available to more than those who are emergency and urgent cases. That used to be the case and should be again.
Some words have changed their meaning. The word “affordable”, in relation to rent, rapidly needs replacing. I do not disagree with some of what the Minister said but it means that the exorbitant rents that exist in the private sector are now reflected for new tenants in the social sector as well. That is not going to solve any problems.
Finally, as my noble friend Lord Sawyer, said, we are in danger of exacerbating the gap in our society between those who own and those who rent. I would remind my noble friend Lord Sawyer that the most important football result was Millwall 3, Everton 2. However, he makes an important point.
There are wider issues than bricks and mortar in housing—wider even than the safe and secure conditions we seek—because housing has an impact on health, our society as a whole and the dreadful scourge of homelessness. I remind the House that Nye Bevan was Minister for Health and Housing and it may be that a broader remit for the Ministers and the civil servants involved in this field is necessary. For the moment, I thank everyone who has participated and broadly supported the recommendations of the Shelter report. I beg to move.
Motion agreed.

Zimbabwe
 - Question for Short Debate

Viscount Goschen: To ask Her Majesty’s Government what assessment they have made of the current situation in Zimbabwe.

Viscount Goschen: My Lords, this House and another place have taken a close interest in Zimbabwe over many years, reflecting the close ties and shared history which exists between our two nations. There is a great deal of support and good will here towards Zimbabwe and its people, and a universal wish to see peace and prosperity return to that great land.
After the intense period of strife which led in 2017 to the removal from office of Robert Mugabe, there was real optimism that a turning point had come for the economy and for the lot of the ordinary citizen. That is why we have all been so alarmed to see the situation in Zimbabwe get worse and not better since that time. The simple facts are that the agricultural sector was decimated by the farm invasions, and what was once a highly productive farming operation now lies largely fallow. The result is that Zimbabwe, which was once a net exporter of staples including maize, wheat and soya, and of cash-crops such as tobacco and flowers, now has to import almost everything and has little foreign currency with which to do so. What money there is has been largely lost to corruption.
The net result has been rampant inflation and chronic food shortages, including of staples such as bread. I understand that, at this very moment, because of the low level of domestic production of wheat and a lack of foreign currency, bread is now hard to find on the streets of Harare. The Government have introduced a synthetic currency in the form of bond notes and have attempted to control some prices but, because of shortages, the black market is prevalent in every commodity from cooking oil to basic medicines. Everything is difficult to get hold of and everything is very expensive, particularly for the ordinary citizen.
As we know, the Government recently doubled fuel prices through duty increases, which caused panic on the streets among the ordinary people, who have endured great suffering and who knew from bitter experience that the inevitable consequence of fuel price increases would be a knock-on effect on the availability of the very basics of life. Fuel is needed to transport people to work and to bring foodstuffs into the city. In an economy absolutely on the edge, that tips people over.
The protests seen on the streets of Harare were not politically motivated or organised but were driven by fear, desperation and ordinary people’s concern that they are not able to feed themselves and their families. But any protest whatever has been treated as an act of aggression against the state and has been met with violence. There have undoubtedly been credible, well-publicised, desperately troubling reports of the state using the army and the other security forces against its own citizens and of murder, rape, torture, beatings and intimidation. This has particularly taken place in the townships at night. People have been lifted from  their homes. People have resorted to sleeping in trees and in the bush to try to keep themselves safe. This is being done well away from the eyes of foreign journalists and diplomats.
The rule of law, which survived for such a long time under extreme pressure, appears very largely to have broken down. There are many reports of magistrates sending people to jail without trial, and many people have been severely injured. In the important debate yesterday in another place, Harriett Baldwin, the Minister for Africa, referred to a report of more than 1,000 arrests having been made. In a particularly sinister development, the internet was shut down during the height of the disturbances, meaning that people could not communicate domestically or internationally, and many areas of business came to a standstill.
The real tragedy of this situation is that it is entirely a man-made crisis. This has been brought about not by natural disaster but by greed and corruption. Where there is corruption, repression invariably follows to protect entrenched interests, and where there is repression, the economy and the ordinary citizen suffer, as they have done in Zimbabwe for decades.
I draw a comparison with Zambia, where I lived and worked for a period in the late 1980s and early 1990s. In those days, Zambia’s economy was in a pretty poor state, despite relative political stability. Essential commodities were scarce and the basic infrastructure was very fragile. People were poor. However, all the commodities and goods one needed were available for sale in Zimbabwe, the roads were well maintained, the policemen smart and well disciplined, and tourism was thriving, and all this despite the legacy of the civil war. There was an extraordinary period after Mr Mugabe came into office where the country exceeded expectations, before the rot set in.
I shall continue the comparison with the country I know much better, Zambia. It had a peaceful transition of power at the ballot box in 1991, when Kenneth Kaunda was defeated by Frederick Chiluba in the general election, and democracy has prevailed since then. Very shortly before I left Zambia, I remember driving on the roads and seeing people joyfully holding up their fingers as a sign of the hands of a clock. They were saying “the hour has come”. Democracy came, and since then there have been democratic elections. The result has been the liberalisation of the economy and the attraction of investment, including in the retail and hotel sectors. Many farmers were welcomed into Zambia from Zimbabwe and encouraged to set up new production.
There is absolutely no reason why, with the right political will, Zimbabwe could not again be a prosperous, thriving economy. It has significant natural resources, a benign climate, huge agricultural potential, wonderful tourism opportunities and great people. The international community is standing by to help Zimbabwe rebuild itself, and the UK and the broader international community could give tremendous support in the rebuilding of critical state functions and capability—what is known as nation-building. Whoever leads the country out of this terrible state has the opportunity to make their mark in history: the history of Zimbabwe and that of post-colonial Africa. However, this can come  only with a profound commitment to reform of the rule of law, economic management and democratic liberty.
So what can be done? The answer undoubtedly lies in a firm, multilateral response from the Commonwealth, the United Nations, SADC, the African Union, South Africa and indeed the European Union. However, it remains the case that on the world stage many countries look to the UK to take a leading role, given the depth of our understanding of the country and the closeness of our contacts. It is clear that the Government of Zimbabwe want to rejoin the Commonwealth, and it is equally clear that there is no question of them doing so without significant reform. Will the Minister set out the agreed position of the Commonwealth towards Zimbabwe potentially rejoining in due course? What discussions has he had with his counterpart Commonwealth Ministers? What discussions have Her Majesty’s Government had with the South African Government and with other members of SADC? Does the Minister agree that the credibility of neighbouring countries, in particular South Africa, will be judged by their response to this crisis? For too long other leaders have decided to look the other way, but that is to be complicit, and as long as this situation prevails, the reputation of the region will continue to suffer. Will the Minister tell the House the result of the EU-African Union bilateral to which he referred in answer to the Private Notice Question asked by my noble friend Lord Hayward last week?
Some might ask why we should care, as surely this is someone else’s problem. We should care very much because we can help, because the humanitarian situation is so bad and because we can play a significant role in coalescing international opinion to try to deliver change in that wonderful country where the footprints of the United Kingdom are still to be seen in the sand of that land. I thank all noble Lords who are going to speak in this debate.

Lord Chidgey: My Lords, I congratulate the noble Viscount, Lord Goschen, on securing this debate at such an appropriate time. He referred to neighbouring countries that I, too, know fairly well, including not just Zambia but Botswana. There is a hub of countries which we can compare with Zimbabwe.
Reading a blog from an expatriate Zimbabwean returning to his country from Cape Town reminded me of the times when my organisation had thriving design offices in burgeoning Bulawayo and Harare. I shall quote the anonymous blogger:
“Once upon a time, my country was one of the most developed in Africa, with an envied infrastructure and education system. It was … blessed with abundant mineral resources, well-educated people, and regarded as Africa’s bread basket”.
The city streets were well maintained and people took pride as they walked around the centres of Bulawayo and Harare, which were free from hustlers and street vendors. He went on to write that,
“things started changing ... The roads are rutted … and full of potholes. The struggle is real as people’s stories tell of hardship, deepening poverty and unemployment. The youths standing on street corners … drug use. Communities are falling apart …  
Christina Lamb, foreign correspondent of the Sunday Times, reported that just the other afternoon in Pumula in the Bulawayo suburbs, two girls—one aged 11 and the other 12—were playing between each other’s homes. They made the mistake of peeping through the wall of the police station to see what had happened to their neighbours, who had been locked up. They were spotted by the soldiers, dragged inside the compound and raped in the courtyard.
Rapes, beatings, floggings, shootings and murders, handed out by the army, have become commonplace as a reign of terror spreads across Zimbabwe. In this regard, we must congratulate the DfID personnel and the whole UK FCO team in Zimbabwe on the outstanding support they are giving to the victims. The abuses are the worst seen in Zimbabwe for at least a decade, dashing any remaining hopes that the departure of Mugabe would lead to political reform. Leading human rights lawyer Beatrice Mtetwa states that there can be no question but that Zimbabwe is under military rule—the army is in control.
In response to the strikes in protest at the doubling of fuel prices and the crackdown by troops using systematic and brutal torture, government spokesmen reportedly said that the people had to learn to behave “correctly”. Hundreds have suffered gunshot wounds and more than 800 citizens—possibly over 1,000—have been arrested, often without reason or charge, since the “stay away” protests were called by the unions. The monitoring report by the Zimbabwe Human Rights Commission on the “stay away” and the subsequent disturbances resulting from the deteriorating economic and security situation highlighted that on 16 January the commission’s monitoring teams were denied access to, or any interaction with, those detained in police stations across Harare and Bulawayo provinces. Efforts to monitor detainees proved futile.
Nevertheless, the commission has produced an extensive monitoring report on the actions of the police and on the military crackdown and arrests. It reports on the losses of life through gunshots—at least 12—and the targeting of members of the opposition and civil society organisations. It reports on the beatings and arrests late at night, the denial of bail, the excessive use of force and police brutality, and countless examples of breaches of citizens’ rights under the constitution.
There are chilling parallels with Zimbabwe’s history under the Mugabe regime, perpetrated in the past by Manangagwa, reinforced by the demands for personal enrichment by those leading the Government and the armed forces by directing the country’s precious resources into their own pockets.
Over the last 12 months, the UK has given financial support to election monitoring initiatives and has set up a $100 million investment facility for growing businesses in Zimbabwe—the first such initiative for 20-odd years. Can the Minister say whether this initiative is now under review? In April last year, the Government strongly supported Zimbabwe’s application to rejoin  the Commonwealth. Are they now reviewing their support for that application, given the fresh outbreak of atrocities?
According to Stevens Mokgalapa writing in the Zimbabwe Situation, lifting sanctions would serve only as a reward to the Zimbabwean Government. President Ramaphosa and the Minister of International Relations, Lindiwe Sisulu, have failed to grasp the repercussions of economic and political instability in Zimbabwe on the neighbouring country of South Africa. They must not reward brutal regimes that gun down their own people in the streets. They should use their influence to defend the victims, not to protect the aggressors. Does the Minister agree?
Finally, the Democratic Alliance in South Africa notes that, given the failure to manage border security, the only option is to stop the problem in the first place. South Africa’s standing in Africa, as well as its position on the UN Security Council, are platforms from which to draw attention to the crisis in Zimbabwe. Does the Minister agree? In that context, can he enlighten us on the outcome of the Minister for Africa Harriett Baldwin’s meeting with the AU Commissioner for Peace and Security and the outcome that she hopes to achieve during her visit to the region?

Lord Hayward: My Lords, first, I congratulate my noble friend Lord Goschen on obtaining this debate and I thank him for his kind comments in relation to my PNQ last week.
I would like to touch on just two subjects. One is my experience of having been an electoral observer in Zimbabwe last year, and the second is the role of South Africa, which the noble Lord, Lord Chidgey, also referred to. However, before I do so, I pay credit to Christina Lamb, who has been referred to previously; to Kate Hoey in the other place for her constant pursuance of assistance and democracy in Zimbabwe; to DfID for the efforts and money that it put in in relation to funding work at the election last year; to the Foreign and Commonwealth Office for its very quick action over the last few weeks, to which I paid credit in the Private Notice Question last week; and to the Commonwealth observers, with whom I shared the honour of being an election observer last year, and in particular the noble Baroness, Lady Jay, who unfortunately cannot be here today. I believe that, although limited, our role in the election helped and, along with the other observers, it enables us to comment on what happened.
As far as I am concerned, the election in Zimbabwe last year fell into three categories. The first was the unfair period in the run-up to election day. Communication through the media, funding and assistance were dominated by ZANU-PF. There is absolutely no question but that nobody else got a look in. The chiefs played a major role. I lived in the country many decades ago and was struck by how unchanged that influence has been in an apparently modernising country. The development of the country in that period was most depressing. As I and my colleague Sabrina Grover from Canada headed out to Matabeleland North, we were driven by an individual who commented on the lack of development in Harare over the last few decades.  The significance was that he was a qualified architect, but he had had no work for the whole of his adult career because there had been no development in the country. In that first period, the Zimbabwe Electoral Commission failed to take any action on the dominance of the media and the bias that I have referred to.
The second period—election day itself—was remarkably fair and peaceful. Here, I pay credit to all the employees who carried out the election and to the thousands of observers across the country. Before election day, they all slept for several nights on the floors of unlit, unheated and, in many cases, seriously degraded schools to protect the ballot boxes. Overwhelmingly, the election day went smoothly.
The post-election day—the third category—was another matter. We saw the murders of demonstrators in the centre of Harare only eight blocks from where we were staying in our hotel. We saw the looting of the MDC offices and the arrest of a number of MDC candidates and employees. The significance of that looting was that the MDC lists of supporters are now in the hands of the Government. Therefore, although what we have seen in these last few weeks has been random in many cases, as has already been identified, there is the potential that those who worked so hard and so peacefully will be persecuted, arrested and attacked. Is it not ironic that the person leading those arrests and attacks himself only fled Zimbabwe under an illegally obtained evacuation order smuggled into his house last October? He had to burst his way through Forbes border post with the support of his family, blocking the guns of the Zimbabwean military—that is, President Mnangagwa. So twice in his life he has faced persecution, yet he seems willing to do the same to his own population now.
I could comment much more in relation to the election but I shall pick on one particular occasion. On the night of the actual election, Sabrina Grover, the Irish ambassador from Pretoria, a DfID representative from the British embassy and I were standing outside a polling station in a rural area in Matabeleland North. We were approached in the darkness by a man who wanted to protest about a random arrest that had happened at his polling station earlier in the day. That is the sort of thing that can and does happen and there were many other instances. But overwhelmingly, election day went well.
As has been identified, the key to this is South Africa, which has the power, influence and capacity to help, aid and intervene in Zimbabwe if it so wishes. One of the most striking things in relation to the election was that, before election day, we were given the figures for registration in Zimbabwe. The number of women massively outnumbered the number of registered male voters. Why? Large numbers of men have gone to South Africa because that is the only place they might get work. We do not know the numbers involved—perhaps 1 million or 2 million—but the situation was shown up by this imbalance.
The South African Government can intervene, and not only to the benefit of the Zimbabwean population; in doing so, they can ease the problems of unemployment and depression in South Africa as well. I wholeheartedly welcome this debate and I hope the Government,  along with many other Governments in the world, can make progress with President Mnangagwa and his Government.

Lord St John of Bletso: My Lords, I join in thanking the noble Viscount, Lord Goschen, for introducing this very topical short debate. I, like many, had great hopes and expectations that the end of the Mugabe regime and the election of President Emmerson Mnangagwa would herald a new dawn of rebuilding political and economic stability in Zimbabwe.
Sadly, my high expectations and those of many others have been severely dashed. Many believe that the political and economic situation has deteriorated even more, leaving citizens grossly underwhelmed. While the recent street protests were triggered by the doubling of the fuel prices, this was just one of the multiple dimensions of the current Zimbabwe crisis.
There are, in essence, four key aspects to the current malaise, the first being the political crisis stemming from the contested legitimacy and leadership of the President, with clear divisions between him and his deputy, Constantino Chiwenga. The political crisis also has a constitutional dimension in that the traditional structure of checks and balances between the legislature, the Executive and the judiciary are just not there: the state is now captured by the military and more compromised. Secondly, there is the economic crisis, which has been manifested by a crippling debt trap, huge unemployment and a debilitating currency crisis. Thirdly, and most importantly, the human rights crisis has resulted in a suspension of fundamental freedoms, unlawful killings by the state, systematic torture and mass rape of women and children as extra- judicial instruments of punishment. The final aspect is international isolation, which has seen the President seeking assistance from Russia.
After the recent atrocities by the military, where live ammunition was used to kill innocent civilians and opponents to the regime were hunted down, much of the population of Zimbabwe has lost all faith, in both the military and political leadership, and people fear that their voices are not being heard by the international community. The move by the state to shut down the internet and social media was another flagrant abuse of human rights and associated with authoritarianism.
In his inaugural speech when he took office, the President undertook to promote economic stability by respecting property rights, repealing the indigenisation Act and tackling the multi-layered currency crisis. He also undertook to have an independent and respected judiciary, which applies the law, and an independent and respected police force, which enforces the law. Sadly, Zimbabwe has descended into a lawless state where none of the four pillars of democracy is functioning effectively, and which is being subverted by a kleptocratic elite. Moreover, there have been strong rumours that Vice-President Chiwenga has been attempting to unseat the President but has not managed to garner sufficient military support.
There are, however, a number of encouraging developments. The recent move to allow companies and individuals to transfer dollars electronically is to  be welcomed. There have been calls for financial assistance by South Africa to alleviate the humanitarian crisis— I hope that this will be made conditional by South Africa on political reforms in Zimbabwe. The economic reforms introduced by the Minister of Finance, Mthuli Ncube, have been slowly starting to take effect, but the move to double the fuel price overnight was deeply irresponsible and reckless.
The nature of the political crisis requires a negotiated political solution, but the relatively low level of trust between the key players, Mnangagwa, Chiwenga and opposition leader Chamisa, means that this is highly unlikely. Ideally, to attempt to restore the public’s trust, there should be a Government of national unity, with a negotiated transition. International calls for the demilitarisation of Zimbabwe, I fear, are a long way away. The military and political leaders appear determined to keep hold of the levers of power rather than relinquish them for the promise of what they see as an uncertain longer-term upside of support by the international community.
DfID and the CDC have played an important role in trying to reduce poverty and promote economic recovery. I believe that efforts should be focused more on the private rather than the public sector in Zimbabwe. Any aid to the public sector in Zimbabwe should be conditional on political reforms.
My allotted time is up. There is currently no clear fix or solution to the current crisis. Like the noble Viscount, Lord Goschen, I hope that, in time, Zimbabwe will rejoin the Commonwealth but this will require a rigorous set of preconditions to be met.

Baroness Redfern: My Lords, I too thank the noble Viscount, Lord Goschen, for initiating this short debate today, following the Oral Question last week by my noble friend Lord Hayward, and I am grateful for the opportunity to take part.
A full week has passed, and still we hear and read about the continuing, disproportionate use of force to retain order. The situation originated from the announcement of steep increases in fuel prices earlier this month. We are told that the price rises were meant to tackle fuel shortages, but they mean that Zimbabwe now has the most expensive fuel in the world—and the people are poor. All this is happening in a country which has lots of economic minerals such as platinum, gold, diamonds, chrome, coal, nickel and many others, which should have been used to help develop this lovely country. Even basic commodities such as food are affected. Not many years ago, there was a vibrant agricultural sector, but now the country relies on imports. Food costs three times the average person’s salary; fuel and medicine remain scarce and are increasingly expensive; and all this is coupled with large-scale unemployment, making further protests likely.
Many crimes committed by the security forces have gone unreported to the police because victims are often fearful of detention or further violence. With women allegedly being raped by the security forces during these night raids, they too live in fear. With so much distrust, they dare not report against police or soldiers. There are further reports, too, of security  forces entering houses at night and making men and even boys as young as 11 lie on the ground, where they are beaten. We read that over 600 people have been arrested, with 60 people being treated in hospital for gunshot wounds. It was reported a few days ago that a 22 year-old man on his way home from work was stopped by soldiers and beaten with iron rods, which was followed by a government spokesman saying:
“When things get out of hand, a bit of firmness is needed”.
And courts are struggling to process the huge number of detainees.
Seeing the end of Mugabe’s rule prompted widespread optimism that the repression of previous decades was over, but, regrettably, it seems even worse. We have seen this level of violence in Zimbabwe for at least a decade now, and it seems to stall any remaining hopes that the end of those 37 years of Mugabe’s reign would lead to major reforms of that beautiful country. Since then, the military have become even more of a significant player in social, political and economic affairs, with retired officers being appointed to key Cabinet roles and overseeing, as we heard earlier, the shutdown of the internet.
It is in the gift of countries such as the UK to protest, monitor and challenge human rights issues in Zimbabwe, as well as continuing to voice UK concerns regarding corruption. As we are all well aware, corruption places in danger any economic growth. I look forward to the Minister’s response.

Lord Collins of Highbury: My Lords, I too thank the noble Viscount, Lord Goschen, for initiating this timely debate. As he rightly said, there was great hope that the departure of Robert Mugabe would usher in a new era for Zimbabwe. However, any optimism has now evaporated. Since the presidential elections, we have seen the killing of protesters, the arbitrary detention of opposition activists and further curbs on the freedom of the press.
As Harriett Baldwin said in the Westminster Hall debate yesterday, the Zimbabwe Human Rights Commission has recorded a wide range of human rights violations since the fuel protests and general strike that began on 14 January. She said that at least eight deaths and many injuries were reported. There are credible reports that arrests may exceed 1,000, and many are still detained. She expressed particular concern at the targeting of opposition and civil society in the wake of the protests. Has the UK specifically raised with the Zimbabwean authorities the violent repression and targeting of trade unionists by the police and security services which has resulted in the general secretary and president of the Zimbabwe Congress of Trade Unions being arrested and charged with subverting a constitutionally elected Government? They are on remand until 8 February, with bail hearings this week.
On his return to Zimbabwe, President Mnangagwa committed to holding his security forces to account for human rights violations and spoke of the urgent need for a national dialogue and reconciliation. However, as Harriett Baldwin said yesterday, words need to be followed by deeds. I hope the Minister will urge the Government of Zimbabwe to immediately release the  trade union leadership so that they can engage in good-faith negotiations with them on a peaceful and constructive way out of the economic crisis, with full respect for human rights and workers’ rights.
The Minister assured the House last week, during the Question from the noble Lord, Lord Hayward, that the UK was working very closely with international partners such as the SADC and the African Union and in particular with South Africa to urge the Government of Zimbabwe to stop their disproportionate use of force. We know that Harriett Baldwin, the Minister for Africa, attended the EU/AU ministerial in Brussels on 21 January to discuss Zimbabwe in particular. Yesterday, she reported that she met the African Union commissioner for peace and security to raise the UK’s concerns. The African Union is an imperfect but important organisation for influencing change and exerting pressure on Governments to adhere to the provisions in the African Charter on Human and Peoples’ Rights. As we have heard, Harriett Baldwin is travelling to the region this week to urge a co-ordinated international approach to the crisis. Can the Minister set out how the Government intend to work with the African Union on ensuring that the human rights, protections and freedoms of the people of Zimbabwe are upheld?
As Harriett Baldwin also reported yesterday, and as we have heard mentioned in today’s debate, targeted EU sanctions remain in place, including on Vice-President Chiwenga. Can the Minister indicate whether our discussions with allies there involve any plans to extend those sanctions, or indeed introduce new ones, to put more pressure on the Government of Zimbabwe?
On development aid, I acknowledge DfID’s long-standing decision not to channel funds directly, which, as we heard from the noble Viscount during the debate, flows from concerns about the role of the ruling party, ZANU-PF. Taking it sector by sector, 50% of DfID spending in 2018-19 will be on human development, with economic development the second biggest sector on 24%, while 18% will be spent on governance and security. I understand that there are currently 19 active UK aid projects. What assessment has been made of the governance and security projects? Can the Minister assure the House that no funds are ending up in the hands of the Zimbabwean Government or their agents?

Lord Ahmad of Wimbledon: My Lords, I join all noble Lords in thanking my noble friend Lord Goschen for tabling what is in every sense a timely debate. Perhaps it has been made even timelier since earlier today I had the great honour to attend, along with several noble Lords, a service at Westminster Abbey for the late Lord Carrington. His role in Zimbabwe’s independence and bringing about the negotiations that took place is a poignant reminder of the hope and ambition that existed.
I thank all noble Lords for their contributions. Recent developments, as several noble Lords, particularly my noble friend Lady Redfern, have said, are of significant concern. The response of Zimbabwean security forces to recent protests has been not just disproportionate  but reminiscent, as my noble friend said, of the darkest days of the Mugabe regime. They have used live ammunition, carried out widespread and indiscriminate arrests and unleashed brutal assaults on civilians, with clear disregard for the due process of law. The noble Lord, Lord Collins, mentioned the Zimbabwe Human Rights Commission, and he was right to cite that at least 470 cases of assault, included 80 that are gunshot-related, have been reported. He raised the important issue of the recent arrests of trade union officials. Because the situation is so fluid, I will write to the noble Lord to furnish him with specific details about this, but I assure him that we are watching these cases very closely.
My noble friend Lord Hayward paid tribute—a tribute shared by all of us—to the journalists who have shown great courage and whose reports have conveyed the footage of young men and even children being beaten up by soldiers in broad daylight. We have received accounts of atrocities committed by security forces during the violent crackdown, including raping of civilians. There have been indications of at least nine reported rapes, some of which appear to be politically motivated.
As was reported, President Mnangagwa returned to Zimbabwe a full 10 days into the crisis. He committed to hold security forces to account for human rights violations and spoke on the urgent need for national dialogue and reconciliation. We welcome these words. The President must also—as my honourable friend Harriett Baldwin, the Minister for Africa, who was quoted by the noble Lord, Lord Collins, said—act to stop the abuses and make good on these commitments. We are particularly concerned by the targeting of the opposition and civil society in the wake of the protests, another point ably made by the noble Lord, Lord Collins. President Mnangagwa’s Administration must now act. They must learn lessons from these events and the tragic violence that followed the election last year, which was witnessed directly by my noble friend Lord Hayward.
The President must also, as he promised, implement the recommendations of the commission of inquiry into the 1 August violence. In particular, he must address the finding that the use of force by the security services was unjustified and disproportionate. As several noble Lords mentioned, the Government’s internet shutdown was a disturbing curtailing of freedom of expression and the media. Her Majesty’s Government intervened directly through my honourable friend and our ambassador, and I am pleased that the High Court of Zimbabwe ruled the shutdown unconstitutional on 22 January.
Several noble Lords drew attention to the UK’s response. My noble friend Lord Goschen asked about the outcome of the EU-AU meeting and about SADC. During the debate, my honourable friend’s visit to the region was mentioned. She is in South Africa today and I can assure noble Lords that this is a subject of specific discussion. The noble Lord, Lord St John of Bletso, mentioned this meeting and I assure him that all these issues are being looked at very seriously. I agree with noble Lords that South Africa has a key role to play in this. I also assure noble Lords that  FCO and DfID officials have raised Zimbabwe directly with the Commonwealth Secretariat; I will come to the Commonwealth in a moment. The British ambassador in Harare has also met her counterpart from South Africa, so we are working very closely on this.
The noble Lords, Lord Chidgey and Lord Collins, asked about the specific outcome of the meeting with the African Union commissioner. Mrs Baldwin met him on 22 January and highlighted the UK’s concern about the situation in Zimbabwe. The African Union has emphasised the need for the security forces to respond proportionately and respect human rights standards. We will continue to work very closely with it. The noble Lord, Lord Chidgey, also rightly raised the issue of the economy. We all recognise the importance of debt relief for Zimbabwe. I assure him that the UK and others have been clear that any support for arrears clearance or debt relief will depend on seeing real progress with economic and political reforms. A number of those reforms were highlighted by my noble friend Lord Hayward in the report after the elections last year.
Minister Baldwin told the ambassador that we expect Zimbabwe’s security forces to stop using disproportionate force, and that the Government should reinstate full internet access. My right honourable friend the Foreign Secretary repeated this message publicly to President Mnangagwa on 21 January. Yesterday, Minister Baldwin spoke to Foreign Affairs Minister Moyo to reiterate our concern and call for an end to ongoing human right abuses. As I said, she is in South Africa today. In addition, Melanie Robinson, our ambassador on the ground, met the Home Affairs Minister on 23 January and had a substantive meeting with Minister Moyo on 25 January. The ambassador also met the opposition leader Nelson Chamisa on 16 January.
The noble Lord, Lord Collins, raised the important issue of civil society groups. I assure him and all noble Lords that we continue to engage directly with civil society groups to ensure that we not only record the violence that has taken place but bring perpetrators to account with the authorities. Noble Lords are right to point out that the UK provides extensive financial and technical assistance to civil society organisations in Zimbabwe which support Zimbabwean citizens in holding the state to account. As I am sure all noble Lords will appreciate, we do not publicise our partners to avoid putting them directly at risk—a very poignant point in the current circumstances.
On the humanitarian situation, the fact that the recent unrest was sparked by a rise in fuel prices illustrates the desperate economic situation in which many millions of Zimbabweans find themselves. Our international development programme continues to support the people of Zimbabwe through the economic crisis; we are giving £86 million in aid this year. The noble Lord, Lord Collins, asked where we are channelling that money. In the last five years alone, we have provided ongoing access to clean water for 2.3 million people, given nutrition support to 1.3 million people, including adolescent girls in education and children aged under 5, and helped 96,000 children to gain a decent education.
On re-engagement, the UK stands ready in friendship; the noble Lord, Lord St John, made this point. We are friends of the people of Zimbabwe and want to see a  change in Zimbabwe not just for the sake of the country and its neighbours but for its standing in the wider world. We will work together with national partners in pursuit of that objective. I assure my noble friend Lord Goschen and others that we are working with international partners, particularly SADC and the EU, and will continue to do so. As several noble Lords noted, Minister Baldwin attended the EU-AU ministerial meeting in Brussels last week. During that time, as I have already reported, she met with the Commissioner for Peace and Security to discuss the situation in Zimbabwe.
A question was raised about Zimbabwe’s application to rejoin the Commonwealth. As Foreign Office Minister with responsibility for the Commonwealth, I can confirm that, after the elections last year, we were supportive of Zimbabwe’s potential return to the Commonwealth. Indeed, a meeting was held on the margins of the Heads of Government meeting. However, as all noble Lords will know, it is not just for the UK to decide whether Zimbabwe can rejoin the Commonwealth; the final decision lies with all members. I assure all noble Lords that the UK will support readmission only if Zimbabwe meets the admission requirements by complying with the values and principles set out in the Commonwealth charter. The disproportionate use of force by security forces, the detainment we have seen and the abuse of human rights suggest very clearly that this position is not yet attainable.
We have been clear with the Government of Zimbabwe that if they wish to rejoin the Commonwealth, this can only be based on genuine and sustained political and economic reform, points well made by my noble friends Lord Goschen and Lord Hayward. The events of the past two weeks demonstrate, however, that they have a long way to go.

Lord Howell of Guildford: If my noble friend would forgive me, I have not spoken in the debate but have attended it throughout and it has beenexcellent. Is it not worth bearing in mind that not only is he an excellent Minister with responsibility for the Commonwealth but we are the Chair-in-Office of the Commonwealth at this moment? Is it not possible to be more proactive? Zimbabwe used to be a great member of the Commonwealth, but of course it left and there is now a disaster. Its plight and the impact of this on the whole of Africa and surrounding Commonwealth countries is very serious. Is it not possible to organise a stronger voice through the 53 Commonwealth members, including the great powers of Asia, in determinedly discouraging the Zimbabwean authorities from pursuing this hideous course? It is wrecking its chances and its prosperity.

Lord Ahmad of Wimbledon: My noble friend makes a very pertinent point. I assure him that, as Chair-in-Office, we take our role very seriously. This will be a subject of formal and informal discussion among Commonwealth countries. I assure him that we are using all channels, but most notably we are working with our key Commonwealth partner, South Africa. It has a major influence on the future relations throughout Africa, and particularly on developments in Zimbabwe. I will certainly take particular note of his suggestion, but it is clear that the Commonwealth stands united if these  reforms cannot be met. As recent events have shown, words alone are not enough; we need to see action on political reform.
In the interests of time, I will write specifically to the noble Lord on sanctions policy, but the existing sanctions policy remains in place. I assure him that we are continually reviewing sanctions and their most effective use, along with EU partners.
It is vital that Zimbabwe’s political leaders focus on doing what is best for its people, with all parties rejecting violence, upholding the rule of law and putting the best interests of the country first. As the Foreign Secretary said in the House of Commons, President Mnangagwa must not turn the clock back. He must move rapidly from words to action on the political and economic reforms that he has set out to work with all Zimbabweans to build a pathway to a better future. I assure all noble friends, including my noble friend Lord Goschen in particular, that Her Majesty’s Government remain committed to doing the right thing to ensure and to install the hope of the Lancaster House agreement almost 40 years ago. As our departed noble friend Lord Carrington aptly said, in doing so, we will always put the best interests of the Zimbabwean people first.

NHS Long Term Plan
 - Motion to Take Note

Moved by Lord Hunt of Kings Heath
To move that this House takes note of the NHS Long Term Plan, published on 7 January, and the case for a fully funded, comprehensive and integrated health and care system which implements parity of esteem, preventative health and standards set out in the NHS Constitution.

Lord Hunt of Kings Heath: My Lords, in opening this debate I declare my interests, particularly those relating to health, as listed in the register. The NHS gives extraordinary care to people in the United Kingdom. It enjoys huge popularity. Yet it is struggling. Austerity has taken its toll. We have seen a deterioration in services and the key access targets have not been met for many a month. Add in increased rationing of treatments, cuts to public health funding, inadequate mental health services and disinvestment in social care and it is hardly surprising that the NHS faces unprecedented pressure. This is what makes the NHS plan so important and why it is important we debate it today to try to turn this around.
I can say at once that much in the plan is welcome: the expansion of primary and community care; the drive for integrated care; the emphasis on clinical services for young people; and the identification of clinical services for cancer and cardiovascular disease, for example, where outcomes in this country lag behind many comparable countries. Welcome too is the acknowledgement of the role of carers, which appears a number of times in the plan. Particularly ambitious is the aim to transform services, using technology to  provide many more online interventions and reduce patient visits to out-patient clinics by up to a third. The plan also hints at further centralisation of hospital services for major trauma, stroke and other critical illnesses, again to improve patient outcomes.
So the plan’s overall thrust is welcome as far as I am concerned, but my worry is that the Government have not learned from previous efforts to transform and integrate services. For a start, the plan is almost entirely focused on the National Health Service. It is a great pity that it was published in advance of the Green Paper on adult social care. It also shows scant recognition of the crucial role of local government, particularly in the current crisis in social care, yet the intended integration of health and care simply cannot happen without local authorities being full partners and some kind of long-term funding settlement for social care.
Similar challenges await the NHS, it seems. The plan promises increased investment in primary and community care, but where will it come from when acute hospital services are at full stretch and demand for services will inevitably grow? Although the plan is a sensible statement of intent, the question is: where is the beef to make it happen?
I start with funding. It is no surprise that the NHS is under funding pressure. A growing proportion of the population is aged 65 or over. We already have 2.9 million people with long-term multiple conditions. This is bound to grow over the next 10 to 20 years. It is always hoped that new technology will reduce costs, but the experience of health so far is that it tends to increase costs. If we add that to the current deficits among providers, the demographic challenge and the additional commitments given in the plan, there is a big bill to pay.
The report of the Lords Select Committee chaired by the noble Lord, Lord Patel, who cannot be here today, recommended that funding for the NHS should increase at least in line with GDP. We know that the consensus among health policy analysists is that we need 4% real-terms growth per year to meet these kinds of challenges. This is what the NHS received in patches, but on average, between 1948 and 2010. Since then it has flatlined at about 1% real-terms growth. Even the injection of an average of 3.4% over the next five years will not make this up.
According to the plan, the intention is for the NHS to return to financial balance. Productivity will increase, and the growth in the demand for care will be reduced through better integration and prevention. Overall, the plan presents this as a cohesive response to the funding crisis. All I would say is that that is a courageous offer from the NHS.
Alongside funding, the other big challenge is the workforce. We already have fewer doctors and nurses than any comparable country. This is likely to worsen in the near to medium term. The GMC—I declare an interest as a board member—points out that one in five doctors aged 45 to 54 are considering leaving the profession in the next three years. Even more worryingly, nearly a quarter of doctors in training and just over a fifth of trainees have informed the GMC that they feel burned out because of their working conditions  and pressures. We know that other professions face similar challenges. We know too that we have a big problem with the largely low-paid social care workforce.
A big question to put the Minister is why the workforce implementation plan, which is some months away, was not published alongside the 10-year plan. What confidence can we have that the forthcoming spending review will provide the funding that, in the context of Brexit, is bound to be required for a huge increase in the number of training places? Also, why on earth are we having an NHS workforce plan? Why can we not have a health and social care workforce plan? The document preaches integration, but the Government have a wholly disintegrated approach, with no joint plans for money, the vision or the workforce. I say to the Minister: if the Government are serious about integration, for goodness sake start integrating your own efforts.
I will briefly touch on technology. I should again remind the House of my membership of the advisory board of Sweatco. The Secretary of State is putting a lot of effort into technology and the use of artificial intelligence. I support and welcome that. However, the report produced this week by the Academy of Medical Royal Colleges on some of the ethics involved in artificial intelligence is well worth reading. It makes the point that if technology is thought to help reduce demand on the health service, the Government might get a shock. As the academy points out, many of the technology approaches might actually encourage people to make greater use of health care, rather than being a sensible demand measure. I do not think the Secretary of State has quite got the hang of that yet, but he will need to if we really are to make the most of technology. The plan is lacking in detail on how performance and standards will be maintained, or how the impact of technology on patients, the workforce and cost-effectiveness will be assessed. We need to see that detail.
I refer noble Lords to my trusteeship of the Royal College of Ophthalmologists in saying that one example of something that works is the National Ophthalmology Database. It is a clear example of a large-scale audit that has improved the quality and safety of cataract surgery, reduced unwarranted variation and is making savings. Yet at the same time as we are being promised this great investment in technology, that database and others are in danger of being pulled because the department and NHS England are not making available the money to fund them in the future. I hope that the Minister might agree to meet me to discuss this, because it is one thing to say that we are going to have a great technology expansion, and quite another when some of the basic building blocks are being reduced or taken away.
On public health, which is perhaps the most disappointing aspect of the 10-year plan, the Government had an amazing report from the Chief Medical Officer just before Christmas in which she spelt out the problems of health inequalities and had a tough message for the Government. She said, “You’ve got to take this seriously”, and that hard fiscal measures to deal with obesity and some other public health issues are really the only way to make an impression. The 10-year plan ignores this  altogether. My interpretation of it is that it is all down to individuals, and only individuals, to improve their own health. It is very disappointing that the Government have chosen to ignore the words of wisdom from their own Chief Medical Officer.
I want to touch on targets. As noble Lords will know, the standards for the NHS are set out in the NHS constitution but they are not being met. The plan is silent on this. The only thing that we know, from an announcement this week, is that the four-hour A&E target will be changed and relaxed. I know that the argument from Simon Stevens is that the target will be prioritised for the most serious illnesses. I understand that and accept the reasons for it. The problem is that for conditions that are felt to be a lesser priority, the four-hour target will no longer apply. I really worry that we will go back to the bad old days of people waiting for hours and hours in our A&E departments.
Whatever the views on targets, I have no doubt that that four-hour target helped to smarten up the NHS. It got rid of a lot of the fears the public had about long waits. The president of the Royal College of Emergency Medicine has warned that scrapping the four-hour target will have a near-catastrophic impact on patient safety in many emergency departments. This decision appears now to have been made but I hope that the Government will ask NHS England to look again at it.
I come to social care, on which the plan has nothing to say of any importance whatever. The plan actually looks as if it was written by NHS managers, and to produce a 10-year plan without having local government as your full partner to it is quite remarkable and very disappointing indeed. We are still waiting for the Green Paper. We have no idea what will happen to long-term funding for social care. How on earth can the plan be delivered unless social care is a full partner to the health service, and unless local government is brought right inside the building to share the decisions on the future? The one thing I would say to the Government is: for goodness’ sake, where in the report is the social care plan that will complement what is clearly the desirable aim of the 10-year plan itself?
I very much welcome this debate and am delighted that so many noble Lords are taking part in it. I think the Government will find that the plan’s aims receive a lot of support from throughout the House and that there is no argument with what the Government seek to do. But without long-term sustainable funding and a workforce plan that links into the requirements of the future, and without the full involvement of local government in social care, they will not be able to pull it off and that would be a great pity.
I turn to the Chief Medical Officer for my final words. In her extraordinary annual report, she spoke of how healthcare is often seen as a cost to the state but she was very wise in refuting that. As she said:
“The NHS and public health services are not a burden on our finances—they help to build our future”,
with,
“the good health of our nation … the bedrock of our happiness and prosperity”.
Amen to that, and I beg to move.

Lord O'Shaughnessy: My Lords, it is an honour to be given the opportunity to follow the typically penetrating speech of the noble Lord, Lord Hunt. I congratulate him on securing the debate today and thank him for giving this House the opportunity to celebrate the historic investment that the Conservative Government are making in the NHS—I am sure that was his motivation—while giving us the chance to debate how that funding ought to be spent. Constructing a three-minute speech is probably a good discipline for us all, so I will focus my comments today on two issues which are of great significance: integration and innovation.
On integration, the structural centrepiece of the long-term plan is the joining up of healthcare delivery in combined authorities called integrated care systems. This marks a significant departure from 30 years of Conservative and Labour health reform, which had previously focused on creating competition within layers in the healthcare system—primary, secondary and so on. My belief, which I think is reflected in the long-term plan, is that this approach has run its course, not least because it increasingly goes against the grain of the healthcare needs of our people. The median patient is now older, has more complex needs and co-morbidities, and constantly moves between different bits of the NHS to receive their care, so having a vertically integrated healthcare system makes perfect sense.
However, I have two questions for my noble friend that flow from this approach, which as I said is the right one. First, achieving this goal may need primary legislation. Is this something that the Government are prepared to do? If they are, and given the support for integration on the Opposition Benches, the question is whether the Opposition would be prepared to back the Government. Secondly, one concern that has been expressed about these ICSs is that they could create again unaccountable local monopolies. How will the Government counter that risk?
Just as important as making sure that our health service is truly joined up is making sure that patients continue to be able to access life-saving therapies. The NHS has a great history in this area through pioneering surgery, novel drug development, and so on. But as the noble Lord, Lord Hunt, pointed out, the NHS can sometimes look at innovation as something that costs it money rather than making it perform better. I believe that this mindset is changing: look at the sophisticated arrangement between Novartis and NHS England that has led to CAR-T therapies being available here, with the first patient successfully treated; or the sequencing by the NHS of 500,000 genomes in the next five years, bringing truly personalised medicine to people with cancer and rare diseases.
We are making progress, but one critical way in which we can build on that further is to increase the UK’s medical R&D budget. Can my noble friend assure the House that during the upcoming spending review, her department will make a very strong case to the Treasury for a major uplift in the budget of the National Institute for Health Research, which has had a flat-cash settlement over the last eight years? Making the UK the place in the world in which to do clinical  research will ensure that NHS patients are among the first in the world to get life-saving and life-changing therapies.

Baroness Walmsley: My Lords, I too congratulate the noble Lord, Lord Hunt, on his speech. I will focus on obesity and my colleagues will focus on other areas.
Chapter 3 of the plan proposes improvements in cancer, cardiovascular disease, stroke, diabetes, respiratory disease and mental health. But the disease of obesity is often the root cause of these and is one of the top-five risk factors for premature death. Obesity services are mentioned in chapter 2, but the problem is that there is no recognition that obesity is a disease, the prevention and treatment of which is vital to avoiding a wide range of other diseases. Bringing professionals of many disciplines together to work on this in primary care settings is essential to success. This is not all down to the NHS. Local authorities have a big role to play, along with CCGs. However, because of their progressive underfunding, many have had to withdraw services. From 2016 to 2017, the percentage of CCGs reported as commissioning tier 3 services went down from over 68% to 57%.
I was pleased to read that the NHS will provide more access to weight management services in primary care for people with a diagnosis of type 2 diabetes or hypertension with a BMI of 30-plus. But do you have to wait until you get sick to access these services? I was also pleased that the NHS has noticed the remarkable success of the GP Dr Unwin, who got hundreds of his type 2 diabetic patients into remission through low-calorie and low-carbohydrate diets, and is now going to run a pilot scheme of its own. However, professionals working in the field are clear that obesity is not just a lifestyle choice which can easily be reversed by exercising more or eating less—it is much more complex than that. Will the NHS follow the proven cost-effective model of the Fakenham weight management service, which uses a multi-disciplinary team to give personalised tier 3 services to suitable patients? They provide specialist nurses, dieticians, exercise professionals, consultant endocrinologists, psychotherapies and pharmacotherapy, and can refer some for bariatric surgery, which is also very cost-effective.
Recognition of this disease would remove the stigma and mental illness experienced by sufferers, and focus attention on treatment and research. The mechanism of obesity disease is not yet fully understood, but genetics play a part. It appears that the brains of sufferers respond differently to hormones generated in parts of the gut which tell the brain that the person is full and does not want any more to eat. So far, a few drugs have been developed to mimic this normal response, and these have been helpful to many patients. Patients who have undergone bariatric surgery show this phenomenon dramatically. Their diabetes disappears overnight and they lose weight rapidly but do not feel hungry.
Whatever the cause, will the Government make the commissioning of tier 3 weight management services mandatory, because then all CCGs would have to provide them? This could save a lot of misery, and save the NHS millions.

Baroness Donaghy: My Lords, I am grateful to my noble friend Lord Hunt of Kings Heath for initiating this debate. Reading the National Health Service long-term plan is like being invited to a party without any food or drink: no money or plan for social care, no budget for training and educating the workforce, no indication of how local authorities will be able to afford their share of responsibility, and no budget announcement for public health. The National Audit Office has said that the crisis in social care, the state of finances in the NHS and the record staff shortages and waiting lists mean that the £20 billion announced by the Government as part of the 10-year plan could be wasted.
I will concentrate on health inequalities. When the Black report on health inequalities was published in 1980, it had a profound effect on me. It was published on the August bank holiday, and the newly elected Conservative Government rejected it. Thanks to Penguin Books, which published it in 1982, it had a wider audience and a huge impact on health inequalities. Yet here we are again. If you are woman living in Kensington and Chelsea or Camden, you are likely to live 7.4 years longer than a woman living in Manchester or Blackpool. A man living in East Dorset is likely to live 9.5 years longer than a man living in Manchester or Blackpool. The Chief Medical Officer’s annual report indicates that,
“a child born in the most deprived areas would have 18 fewer years in good health than one born in the most affluent areas”.
Infant mortality, working poverty and cuts in benefits are on the increase, with the virtual disappearance of local authority support services, including children’s centres and smoking cessation classes. The geographical variation of working-age individuals on incapacity benefit is also stark: a 13% claimant rate in Blackpool; 8% in the south-west of Scotland, south Wales and the north-east of England and Merseyside; and below 4% in most of the south of England. The brutal closure of primary industries in the 1980s made these variations worse.
I would bet that there is an exact correlation between these areas and those who voted to leave the European Union, alienated every bit as much as from Westminster and Whitehall as they are from the EU. Time does not allow me to make comparisons with other countries, but it is not good. To ensure that the long-term plan works, the Government will need to accept the CMO’s recommendations on spending, housing and migration—that, and enormous political will.

Baroness Browning: My Lords, I too am grateful to the noble Lord, Lord Hunt of Kings Heath, for giving us this opportunity. I pay tribute to the fact that the plan focuses on autism. I declare my interest in the register as a vice-president of the National Autistic Society. The focus on the need to reduce diagnosis waiting times for autistic children and young people is very welcome. Please do not forget the adults in the community who have yet to receive a diagnosis; they are some of the most complex cases for professionals to address accurately.
The need to reduce the number of autistic in-patients in mental health hospitals is something that this House has debated on many occasions, and which I know is a very real problem for many families around the country. The improvement in understanding the needs of people with learning disabilities and autism within the NHS generally has improved, but there is still much to be done. There is also the issue of increasing investment in crisis support: sometimes we deny people small amounts of support and they end up in crisis. That is one of the most expensive ways to address people.
The long-term plan contains a commitment to piloting a new annual health check for autistic people. That is welcome, but I must say to my noble friend on the Front Bench that it is very important that that is done by doctors and professionals who have a good understanding of autism. If parity of esteem is to mean anything, it must be more than just checking blood pressures and weighing people. Checking the mental health of people on the autistic spectrum is probably almost more important than just checking them physically.
In order to do that, it is important that the GP knows who to call. For many years, the National Autistic Society and others, including the Royal College of General Practitioners, have been calling for improved recording of autism in GP registers, so that GPs know more about the needs of their autistic patients. If we do not have a register, and if GPs do not log who their autistic patients are—even if they do not see them very often—who will they know who to call for annual check-ups? It is really important that the need to create a database of who is on the autistic spectrum and where they are is included. That requirement is missing from the report. I hope my noble friend will address that; perhaps she will get back to me and put a letter in the Library of the House. The database has been requested for many years.
On dementia, there is much that is very good in this area, but I hope equally that some of the pilot schemes will not be pilot schemes for too long, and that the process will be speeded up—particularly the side-by-side service provided by the Alzheimer’s Society.

Baroness Masham of Ilton: My Lords, as president of the Spinal Injuries Association, I join others who have spoken about the seriousness of the NHS and social care workforce. The British Medical Association says that the NHS needs a “robust workforce plan”, including additional resources for training, which is missing from the long-term plan. The Royal College of Nursing says that if the Government do not take appropriate action, NHS England will be unable to improve cancer treatment, mental health and care for more patients at home, as outlined in the plan.
Spinal cord injury is a devastating, long-term condition which leads to complete or partial loss of movement and feeling, loss of sexual function and double incontinence. Access to specialised health services is essential to spinal cord-injured people’s rehabilitation, ongoing physical and mental health, and ability to live independently.
Spinal cord injury centres across the country are increasingly experiencing bed closures, as capacity is sought by their host hospital trusts to meet winter  pressures affecting other services. As a result of these closures, it is increasingly difficult for spinal cord-injured people to access specialist healthcare and receive essential treatment for their condition. Without these closures, it has been found that the spinal injuries service needs 54 extra beds to make it viable.
I join Age UK in warning that the number of care vacancies will rise unless the Government take action to allow EU staff to continue to work in the UK. It is said that there are around 110,000 job vacancies in care in England and that around 104,000 care jobs are held by EU nationals. Age UK has said:
“The social care workforce is already struggling but if after a UK withdrawal we shut the door on staff from the EU we’ll make a bad situation even worse”.
The Government should recognise this and allow EU nationals to continue to come and work as paid carers. Coming from Yorkshire, I can say that the latest figures show that almost 4,000 EU nationals are working in adult social care in Yorkshire and Humber.
There are few greater risks to long-term global health than the increasing resistance of many infections to antibiotics. I hope that we will work with other countries across the world to develop new antibiotics and overcome the dreaded killer of antimicrobial resistance.

Lord Turnberg: My Lords, I congratulate my noble friend Lord Hunt on a brilliant speech. I strongly agree with him that the long-term plan is heavy on admirable aspirations but short on implementation in at least three areas: public health, social care and the workforce—I shall focus on just public health and the workforce.
In public health, everyone agrees that our biggest challenges are smoking, obesity, alcohol and air pollution. It is interesting that three out of these four are due to what we do with our mouths—someone said that the most dangerous organ in the body is the mouth, and that is even without talking. However, the brain is more dangerous because all these challenges are due to behaviour and personal choice, and if we are to make a difference we have to influence behaviour.
We cannot place all that responsibility under the public health banner alone. Valuable publicity campaigns against smoking and obesity have been led by the Cancer Research campaign. If we are to reduce calorie and sugar intake, it will depend on the actions of the whole of government to persuade the food industry, possibly by legislation, to make a difference. If we look at how we might reduce alcohol consumption, we see that the best way is by increasing duty on alcohol. There is a close relationship between the rate of taxation and alcohol-related diseases: the higher the tax, the lower the rate of liver disease. If we want to change behaviour, it is the responsibility of the whole of government and not just public health in isolation.
However, there is one vital area of public health that clearly needs support, and that is its role in the control and prevention of infectious diseases. It is Public Health England that detects and controls outbreaks of communicable diseases, nips them in the bud and prevents them by vaccination programmes. Will the  Minister please take that on board? I am afraid that I should reveal my own bias, as many moons ago I was chairman of the Public Health Laboratory Service.
Now what about workforce, where the plan is silent? With 100,000 staff vacancies, mostly nurses, filling that gap is an enormous challenge. The suggestion that we should increase our efforts to recruit nurses from overseas will only go so far, so we must do better at recruiting and retaining UK nurses. We can do things. The first is to fish in the waters of nursing associates and nursing assistants. A large number of them are desperate to be given the opportunity of a career structure that will put them on a ladder leading to a full nurse qualification. We should make nurse associate posts more attractive by offering them the prospect of career progression. We should do much more to attract back into the profession the many nurses who have retired for one reason or another. We do not make nearly enough use of this resource. Will the Government answer that?
In medicine, we have unfilled hospital consultant posts across the board, but much the biggest danger is the shortage of GPs despite all the efforts of government to bring in pharmacists and others to fill the gaps. General practice has now become an unpopular career. Few going into practice are willing to take on a partnership role, with all the administrative burdens that it entails; many want to work part time and many want to retire early. It is not pay that is the issue; it is the increasing patient numbers, the distractions of paperwork and bureaucracy, and the heavy hand of the commissioners that get in the way of what they were trained to do.
There is emphasis in the plan on multidisciplinary teams and primary care networks—hardly novel ideas. I seem to remember writing about them in my review of London’s health services in 1997, and my noble friend Lord Darzi’s excellent review proposed the idea of polyclinics in general practice. That has not lost its attractiveness now that we are jettisoning competition in favour of collaboration. Will the Minister look at these ideas again?

Baroness Tyler of Enfield: My Lords, I too congratulate the noble Lord, Lord Hunt, on securing this debate. Like him, I think that there is a lot to welcome in the long-term plan, particularly the commitments to increased investments in mental health, primary care and community care, as well as the emphasis on prevention and health inequalities.
However, there is also much to worry about—mainly things about which the plan is silent. The NHS does not operate in isolation, and I am concerned—like many other noble Lords—that many of the laudable aims of the plan are being directly undermined by cuts elsewhere to public health and social care budgets. For example, the plan’s commitment to a more concerted and systematic approach to reducing health inequalities is welcome, but it comes at a time when public health funding has been reduced in real terms by some £700 million in five years, according to the LGA. So my first question to the Minister is simple: do the Government plan to reverse these cuts to public health?
Adult social care is facing a £3.6 billion funding gap by 2025. With such a focus on prevention in the plan, it simply does not make sense to underfund social care. In fact, according to the National Audit Office, one-fifth of emergency admissions to hospitals are for existing conditions that community or good social care could manage. Unless we invest sustainably in social care and public health, the funding in the plan will not be well used. Given the vital role social care will play in the success or failure of the plan, it is a great shame that the Green Paper was not published alongside it. Could the Minister give a firm commitment on when the social care Green Paper will be published?
While proper funding is vital, services cannot operate if we do not have the workforce to run them—a point that has already been clearly made this afternoon. The National Audit Office has warned that the NHS will not be able to use its new funding optimally, precisely because of staff shortages. This is a particularly pressing issue for adult mental health services, where more than 20,000 mental health positions in England are currently vacant. These positions are simply not being filled fast enough. According to the charity Mind, mental health trusts employed more than 179,000 staff in August 2017. A year on, this figure had risen by only 1,500—nothing like the additional 21,000 mental health practitioners the Government themselves said were needed to treat the additional 1 million people by 2021. Could the Minister give a date for when the NHS workforce plan will be published?
Finally, I will draw attention to the continuing issue of out-of-area placements for mental health in-patients, about which the plan says little. At the end of June 2018, NHS Digital reported some 680 active out-of-area placements, of which 95% were deemed “inappropriate”. Could the Minister say what precise plans the Government have to tackle the use of out-of-area placements in mental health services?

Baroness Watkins of Tavistock: My Lords, I congratulate the noble Lord, Lord Hunt, on securing this debate, and draw attention to my interests as set out in the register. Like other noble Lords, I welcome the plan and the certainty it brings to health service funding, and in particular the aim to achieve parity of esteem between mental health and physical health through investing in the causes and consequences of poor mental health.
However, it is vital to provide truly integrated social and healthcare services in our population to promote healthier lives and provide support and treatment to those with a range of disabilities, including both physical and mental health conditions. Yet we still await the Government’s Green Paper on social care, which is another essential part of the jigsaw. Without clear indications of the funding source available for social care, the implementation of the NHS plan will flounder, with many people remaining in hospital when they are ready for discharge—not only older people with comorbidities but younger people with learning disabilities and autism, a proportion of whom are still in institutional care despite all political parties’ commitment to eradicating this approach.
Public health budgets have been cut since 2015, yet we know, for example, that for every publicly funded pound spent on contraception there is a saving of £9 over 10 years—before considering the wider societal costs and impacts of unplanned pregnancies. The number of health visitors is being reduced in many local authorities—not necessarily because decision-makers want to do so, but because they must make provision for minimal statutory services, so they are faced with selecting the least-worst options to balance budgets. How swiftly will PHE budgets be restored and increased so that both contraception and health visiting services can be adequately provided?
The noble Lord, Lord Turnberg, and the noble Baroness, Lady Tyler, spoke eloquently on workforce issues, but I want to draw attention to the fact that, while we talk about the NHS having a shortage in the region of 40,000 nurses, there are a number of vacancies in the voluntary and independent sectors—particularly in nursing and care homes. At a conservative estimate, there is a shortage of at least 60,000 nurses in England. Yet the NHS plan says that by 2028 it will improve the vacancy rate by 5%. A simple arithmetic equation tells us that this means only 2,000 more nurses. What impact will this really have in assisting the delivery of the new plan?
Finally, there is a section in the plan relating to limiting A&E admissions for alcohol-related problems. This is an excellent aim, but surely the swiftest effective approach would be to introduce a minimum unit price for alcohol, as adopted in Scotland and recommended by medical experts in public health, not only in England but internationally. Could the Minister tell us how the review on minimum unit pricing in England is developing?

Bishop of Carlisle: My Lords, this NHS long-term plan is very welcome, and from these Benches I commend all those who contributed to it. It is a comprehensive plan—not easy when health is such a wide-ranging topic. It is also realistic about the many challenges we still face. When it comes to issues such as smoking, alcohol dependence and air pollution, I applaud the strong emphasis on public health and prevention, along with the necessary reminder that responsibility for our own health does not belong solely to other people.
This is also an ambitious plan. The noble Lord, Lord Hunt, whom I thank for this debate, referred to it, in true “Yes Minister” style, as “courageous”. In particular—the noble Lord, Lord O’Shaughnessy, reminded us of this—it promises the creation of integrated care systems across England by April 2021 to deliver the triple integration of primary and specialist care, physical and mental health services, and health with social care. This was an important plank in the report of the Lords Select Committee on the future sustainability of the NHS, many of whose recommendations have, I am glad to say, been picked up by this long-term plan. Of course, in practice, as the noble Lord, Lord Hunt, pointed out, this integration will be greatly affected by the details of the forthcoming Green Paper on social care, which has been repeatedly postponed. So we look forward to that and, in due course, as we have also been reminded, to the promised workforce implementation plan.
Others have raised questions about this plan. If I have a criticism, it is that I could find no reference within it to spiritual care, which is offered by chaplains so faithfully, day in, day out, not only in hospitals but now in many GP practices. It can make a big difference to health outcomes and to the general well-being of relatives and friends, as well as patients. This is one of the things that the NHS was set up to provide, so it comes as a rather surprising omission. I am sorry if it is there but I have missed it.
That is also a reminder, should one be required, of the need for effective partnerships between the NHS and organisations in the community and voluntary sector that are closest to vulnerable people or which represent the needs of particular groups that are easily forgotten or left behind. I think in particular of those who work with minority ethnic mental health issues, and countless volunteers who are committed to tackling the increasingly prevalent problems of loneliness and isolation, with all the implications they have for the mental, physical and emotional health of elderly people especially.
The Church of England, together I am sure with other faith bodies, will do everything it can to work with everyone concerned to achieve the plan’s goals, for which we are grateful—although, as others have observed, we are only too well aware of the gap that exists for every institution between aspiration and implementation, and the desperate need for adequate resources in and for the NHS.

Lord Ribeiro: My Lords, Secretary of State Matt Hancock, on taking up office, identified three priorities for the NHS: workforce, technology and prevention. The ambitions set out in the plan cannot be realised without significant improvements in the health and social care workforce. It is therefore disappointing, as other noble Lords have noted, that neither of these plans was published alongside the NHS Long Term Plan, and we will have to wait until the end of the year. Similarly, funding for medical training is welcome, increasing training places from 6,000 to 7,500, but post Brexit more places may be required. NHS Improvement reported 11,576 whole-time equivalent medical vacancies in quarter 1 of 2017-18—a vacancy rate of 9.3%, up from 6.78% in the previous year. This is equivalent to 108,000 clinical staff, including nurses. Add to this the adverse effect of Brexit, which I mentioned earlier, which is likely to reduce nurse recruitment from Europe, and it becomes imperative for us to retain and grow our own staff.
Your Lordships may recall my own interest in preventing smoking in cars with children present. As a surgeon, I was aware also of the effect of smoking on wound healing and, in particular, surgical site infections after operations, the risk of which doubles if patients smoke on the day of surgery. I therefore welcome the plan’s commitment to offer all patients who smoke and who are admitted to hospitals NHS-funded tobacco treatment services to assist smoking cessation. On Public Health England advice, the option to switch to e-cigarettes will be made available. NHS hospitals are an ideal environment to wean patients off smoking, yet the policy on smoke-free zones varies between  hospitals and patients are often not given the help they need to quit. There is an aspiration in the plan to achieve an Ottawa model for smoking cessation. It is used in 120 hospitals in Canada and will, I hope, be used in all NHS hospitals by 2023-24. My question to the Minister is: when will the rollout of the Ottawa model in secondary care begin and what funding for smoking cessation programmes will there be over the lifetime of the plan? Finally, can the five-year plan of the Taskforce for Lung Health be reviewed by the Government to consider the areas not covered within the plan?

Baroness Pitkeathley: My Lords, like many in your Lordships’ House, I owe my life to the NHS, so I am always glad of any opportunity to praise it, for which I thank my noble friend, as well as for his wonderful opening speech. I welcome any initiative that helps the NHS to thrive.
I shall confine my remarks to how I believe the plan will affect the 6 million carers who underpin any service provided by national or local agencies and whose contribution, as I never tire of reminding your Lordships’ House, is valued at £132 billion every year: roughly equivalent to all spending on the NHS.
Last year, Carers UK surveyed 7,000 carers and asked what they wanted from the NHS. They were clear that they wanted the long-term plan to turn the NHS into the most carer-friendly health service in the world, and that that would entail better recognition for carers, better identification of carers and more support for carers. I am very pleased that the long-term plan makes the specific commitment to be the most ambitious ever set of NHS commitments to carers.
The plan details how NHS England will improve how it identifies unpaid carers and strengthen support for them to help them address their individual health needs. It also identifies that carers are twice as likely to suffer from poor health themselves compared to the general population. To combat this, the quality marks for carer-friendly GP practices will help carers identify GP services that can accommodate their needs. There is also national adoption of carers’ passports, which will be helpful.
These are welcome initiatives, but the survey last year found that, even among those carers caring for more than 50 hours a week, as many as one in five said that their GP had no idea that they were a carer, and, even when they knew, only one in 10 had been given advice about where to get support. Can the Minister give more detail about how this identification will work in practice and what support will be given to GPs to enable them to give the help that I know they want to give?
The plan also promises better support for carers in emergencies, and support for young carers is also welcome. I want to know more about plans to support the thousands of carers who are in the NHS workforce. So many of them are juggling their work responsibilities with their unpaid caring responsibilities. Support for them in the workforce is vital if enough staff are to be retained to give the plan even a ghost of a chance of being delivered.
Other commitments in the plan also help carers: for example, social prescribing and the joining up and co-ordination of care. As ever, the important part is not the plan but how it will be implemented in local areas. The patchy record of STPs and integrated care systems may give us some anxiety about that. Above all, there is a real sense that this is a missed opportunity. This is a three-legged stool with only two legs. Alongside the NHS plan, we urgently need ambitious proposals for the funding and delivery of adult social care that have the huge contribution made by carers at their heart. The social care Green Paper, when published—I am tempted to say, if published—must set out concrete measures to support carers and give them practical support without putting their own lives on hold. The future of the NHS itself, as well as the system of social care, may depend on it.

Lord Low of Dalston: My Lords, I congratulate the noble Lord, Lord Hunt, on securing this debate. There can hardly be a more timely and pertinent subject for debate at present than the case for a fully funded, comprehensive and integrated health and social care system in the context of the new NHS Long Term Plan. We have only three minutes, so I shall concentrate on just one thing which I actually know something about: eye health and visual impairment. In doing so, I declare my interest as a vice-president of RNIB and co-chair of the All-Party Parliamentary Group on Eye Health and Visual Impairment.
Sight is the sense that people most fear losing. Ophthalmology has the second-highest number of out-patient appointments of any specialty. Due to demographic factors, the number of people in the UK affected by sight loss is projected to rise by more than 10% by 2020 and more than 40% by 2030. The British Ophthalmological Surveillance Unit—BOSU—found that more than 200 people every year experience severe and permanent sight loss due to delayed and cancelled appointments. Yet, extraordinarily, there is no mention of ophthalmology in the long-term plan.
For these reasons, my all-party parliamentary group undertook an inquiry into capacity problems in NHS eyecare services and the commissioning and planning of such services in England. The inquiry was supported by an independent secretariat hosted by RNIB, and funded by the Bayer pharmaceutical company, which had no role in the scope, development or delivery of the inquiry, however. The inquiry’s report—See the Light: Improving Capacity in NHS Eye Care in England—was published last June and contained 16 recommendations. Obviously I cannot go into all of them in any detail now, but they include measures: to ensure that eye health is accorded higher priority; on how capacity issues are addressed by sustainability and transformation partnerships plans; to ensure that the national tariff for ophthalmology does not disadvantage patients at particular risk of avoidable sight loss who require follow-up appointments; and to ensure that patients requiring follow-up appointments are seen within clinically appropriate timescales.
Finally, eye clinic liaison officers—ECLOs—play a vital role in signposting patients to support in the community following the often devastating trauma of  a diagnosis of sight loss, but their availability is patchy. RNIB is therefore calling for all ophthalmology departments to offer ECLO support. I would be glad to learn from the Minister the department’s thinking on how ECLO services could be rolled out throughout the eyecare service, and to hear that the department is both taking our all-party group’s recommendations seriously and working for their implementation.

Baroness Cumberlege: My Lords, my interests are in the Lords register. This debate is opportune because today we heard an announcement from Simon Stevens on the first steps to implementing the plan.
The NHS is frequently likened to a sea-going tanker. I do not agree with that; I think it is more like a flotilla. Numerous boats sail in the same direction but when the storm rages, the flotilla disintegrates, with each ship seeking its own safe harbour. The 2012 Act enabled disintegration, which is why this plan is so crucial. It seeks to cement new systems to integrate health, on a population base, through integrated care systems. Along with other noble Lords, I welcome that.
The wise and wonderful Sir Cyril Chantler published in the Lancet:
“Medicine used to be simple, ineffective and relatively safe. It is now complex, effective and potentially dangerous”.
That emphasis on being potentially dangerous has driven us to consider how we can make medicine safer while recognising its complexity and the need to involve patients, consumers and citizens. The plan assures us that having a baby is now safer than it was 10 years ago, which we welcome. Nevertheless, giving birth in this country is not as safe as in Sweden. Why? Their teamwork is awesome: they learn from mistakes and avoidable harm, then spread the learning. We do not. The maternity review fashioned a system based on the Swedish system, called “rapid resolution and redress”. We have no confidence that the department will introduce it, so I would welcome some support from the Minister to enable that to happen.
We know that we can improve safety by ensuring that women have continuity of care from the health professional, usually the midwife, to care for her through her pregnancy, the birth and the early days of parenthood. Research shows that with continuity, 19% of women are less likely to have a miscarriage, 24% are less likely to experience a pre-term birth and 16% are less likely to lose their baby overall. Should we surprised by that? Of course not; it is common sense and it is what women seek. Technology has its place and can aid continuity through the use of iPhones, emails and so on, but when it comes to maternity care, robots are not the answer. Women want the skills, the personal knowledge and the relationship they have with their professional friend. Being handed from one midwife to another does not make for a good experience or aid safety. Continuity does, which is well understood in the long-term plan.

Lord Rogan: My Lords, I thank the noble Lord, Lord Hunt of Kings Heath, for providing the House with the opportunity to debate the NHS. The Motion refers to parity of esteem. But, in the continued  absence of a devolved Government at Stormont, I would argue very strongly that the people of Northern Ireland are not being given parity of esteem in healthcare. A recent study commissioned by the Northern Ireland Department of Health revealed that healthcare professionals are struggling to keep the local NHS running.
The Medical School Places Review has found that there are currently 110 specialist doctor vacancies in the Province and an additional 580 specialist doctors will be required in Northern Ireland over the next seven years. The report helpfully includes proposals to address the shortage of specialist doctors, including an increase in training posts and the construction of a new medical school in Londonderry. Responding to the report, the Northern Ireland Department of Health has said that implementing the proposals would cost £30 million a year. However, it has admitted that the money would have to be diverted from funding other local authority services. It also stressed that any new medical school would require approval from a Health Minister. But I would remind your Lordships that Northern Ireland does not have a Health Minister. In fact, we have no devolved Ministers at all and there is no prospect of any being appointed for the foreseeable future while Her Majesty’s Government play footsie with the DUP to stay in office. The situation is becoming scandalous.
Waiting lists in Northern Ireland are substantially worse than in the rest of the United Kingdom. Department of Health figures published in September 2018 showed that 94,222 people in Northern Ireland were waiting longer than 52 weeks for their first consultant-led out-patient appointment. Equivalent statistics for the whole of England showed that just 3,464 were waiting for such a prolonged period. The Royal College of Nursing has recently warned that patient safety in Northern Ireland is being compromised by a shortage of more than 1,800 nurses in hospitals alone. We are also struggling for GPs. There are currently more than 3,000 patients per GP in Northern Ireland, which is unsustainable. Yet the people of Northern Ireland, patients and medical professionals alike, are expected to put up with this as the winter turns increasingly bitter.
Doctors, nurses and other NHS workers cannot be expected to deliver for patients at the levels they do without the necessary support. That includes support from properly accountable Ministers serving in a devolved Administration and scrutinised by locally elected political representatives. The NHS belongs to all of us. I invite the Minister to convey my concerns.

Lord Chadlington: My Lords, I join others in thanking the noble Lord, Lord Hunt of Kings Heath, for initiating this important debate. On page 43 of the long-term plan there is, as far as I know, the first prominent planning reference to the mental health issues associated with gambling. The Government have committed to establishing centres nationally for gambling treatment, saying:
“We will invest in expanding NHS specialist clinics to help more people with serious gambling problems”.
This is welcome news and a hugely important step forward. However, the plan fails to submit gambling to the same forensic analysis adopted for the use of  alcohol or tobacco, where careful consideration is given to education, cessation, prevention and treatment. I remind noble Lords once again of the litany of gambling figures based on information currently available. There are over 430,000 adults with a serious gambling problem, but only 2% are in treatment; 2 million are in danger of addiction; 55,000 children aged between 11 and 14 are already addicted; 75,000 children are at risk; and an estimated two gambling-related suicides occur every working day. Could there be a more compelling case for education, cessation, prevention and treatment programmes?
I am extremely encouraged by the recent meetings I have had with senior executives in the gambling industry. Some are voluntarily adopting initiatives such as doubling their industry levy or advertising tools to control excessive gambling. This clearly demonstrates an appetite for change. However, there is still much more to be done. I therefore ask the Minister, first, whether gambling could be considered in the NHS Long Term Plan in precisely the same way as alcohol and tobacco. Secondly, can the Minister confirm that the Government have held, or are planning to hold, conversations at the highest level with the gambling companies and other stakeholders to find common ground for voluntary and constructive reform?

Baroness Gale: My Lords, I thank my noble friend Lord Hunt for bringing this important debate before us today. I declare an interest as a co-chair of the APPG on Parkinson’s.
The NHS sees 12.5 million neurology-related cases each year. People with neurological conditions have the lowest health-related quality of life of any long-term condition. Public Health England’s 2018 neurology mortality report showed that the number of deaths in England relating to neurological disorders rose by 39% over 13 years, while deaths in the general population fell by 6% over the same period.
While the NHS Long Term Plan details improvements in stroke services, there is no mention of neurology more broadly. Many serious neurological conditions, such as Parkinson’s, are not mentioned, so while the NHS Long Term Plan contains positive steps for mental health, there are still significant concerns about how these services will work for people with Parkinson’s. The recent findings of the All-Party Parliamentary Group on Parkinson’s report Mental Health Matters Too, which I chaired, exposed the difficulties that people with Parkinson’s face in accessing high-quality mental health care. Mental and physical health services currently operate in isolation, leading to disconnected care. Clinicians are experiencing problems accessing patients’ notes and there is poor communication between services.
People with Parkinson’s rate access to a specialist Parkinson’s nurse as their top priority. Nurses are more accessible than consultants and offer the specialist knowledge and support that many GPs cannot. In the 2017 Parkinson’s UK “Your Life, Your Services” survey, those who had access to a Parkinson’s nurse reported higher levels of care, support, information and control over their health, and fewer hospital visits. There are  currently 380 Parkinson’s nurses in the UK, approximately 100 fewer than needed. Measures in the plan to increase nursing levels are welcomed, but I hope this includes Parkinson’s nurses.
I have two questions for the Minister. What steps will the Government take to ensure that the forthcoming workforce plan includes measures to increase Parkinson’s nurses and therapist services to address the rising number of people with the condition, set to be 170,000 by 2025? What action is being taken to ensure physical and mental health services are joined up for people with Parkinson’s?

Lord Scriven: A plan for personalised and predictive systems of healthcare linking together genomics, big data, artificial intelligence and digitisation—is this real or just fantasy? This is the NHS, which recently said no fax machines by 2020, yet the plan trumpets that by 2024 all secondary healthcare organisations will be digitised. This statement may in time be found to be a different type of artificial intelligence.
The NHS will embrace these new ways of working but the Government need to be realistic on the route map and the investment needed to do this. To make this happen the NHS needs to attract, train and retain a digital literate workforce and have open-source systems that have operability across the health and social care systems. I see nothing in this plan about digital linkages between health and social care.
Also, the NHS must be trusted on cybersecurity. Last year, every trust tested by the NHS failed on agreed cybersecurity standards, yet the plan says that there will be fully digitised secondary care by 2024. What risk assessment has been done on this target when it comes to data and cybersecurity? What work is ongoing and with whom to ensure operable seamless systems between health and social care?
The plan states that within three years community staff will have access to mobile digital services. A 2018 survey showed that in community nursing this could not happen as in 81% of cases poor connectivity at the patient’s home stopped it. In 33% it was thwarted by uploaded data that could not talk to other systems it needed to. What other non-NHS departments and mobile network companies are part of this plan to make mobile digital working happen and is the three-year timescale realistic?
This service change will need a workforce that is digitally literate, yet the plan has only eight lines on a digital workforce: unfortunately, it gives a top-down approach through the digital academy. Let us be clear: for this to work, the NHS needs at every level a workforce that is digitally literate and equipped to exploit the personalised and predictive care system that the plan articulates. What workforce planning is happening over and above the digital leadership academy to ensure full digital skills for healthcare staff?
To date, £2.8 billion investment is agreed for IT and digital change until 2021. However, the Health Service Journal in 2018 reported that government estimates showed that £13 billion of investment was needed, of which 60% is revenue not capital. What investment over the £2.8 billion has been agreed for the plan’s digital transformation?
The plan is ambitious for a digitised personalised and predictive care system but it needs to be based on realistic plans and firm investment to make it happen. I hope the Minister can answer the questions I pose to show that this is the case and not just aspiration wrapped in hope.

Baroness Neville-Rolfe: My Lords, I refer to my interests, notably as a director of Health Data Research UK. I congratulate the noble Lord, Lord Hunt, and would like to join him in any meeting on data. I thank the Library for producing an excellent note for this debate.
I am quite new to health as a public policy issue—encouraged by the noble Lord Patel—and have considered the plan de novo. The response has shown that there is overwhelming public support for the NHS and we must take full account of that fact. However, that ought not to prevent us from recognising that the structure of the NHS has drawbacks. I will mention two. It is vast, and therefore bureaucratic, and all experience shows how difficult it is to maintain high levels of efficiency in large bureaucracies. Also the NHS, by its very nature, makes little use of market pricing, making the optimum allocation of resources close to impossible. We must do our best to eliminate inefficiencies, but the NHS is ordained to suffer from some of them.
Given my commercial experience, I regret the overuse of percentages in the plan and the lack of key overall numbers on expenditure and capital formation and on future demography, which is too often ignored in public investment. Value for money is also given very little prominence. Less surprising is the total absence of the notion of enterprise and incentives. This is a pity as GPs are small businesses, and the best are good businesspeople. The fact is that management skills are needed to deliver effective change. The “lean thinking” principles trained into retail could help to cut out waste and blockages. I was reminded of this by the example on page 19 of ambulance paramedics stuck on a hospital ramp with other calls piling up that they could not get to.
I commend the Government on the new focus on digital, personalisation and data. AI is improving the efficiency of drug trials, and there could be vast savings from introducing patient apps for patient records. This would allow easy migration and an end to the familiar cry, “They have lost the notes”. Apps could be introduced immediately for maternity and to replace the red baby book.
I would also like to see support for HDR UK’s digital innovation hubs for the safe sharing of data in R&D and better use of data to improve outcomes—for example, on cancer and antimicrobial resistance. This huge global health issue receives a modest mention on page 39. Are noble Lords aware that, without new antibiotics, routine operations could become too risky and that cancer and paediatric care could become extremely difficult? I welcome the Health Secretary’s initiative at Davos, but we also need worldwide efforts to reduce irresponsible antibiotic use for animals. I was glad to hear the CMO referencing the red tractor label, whose standards have helped to reduce antibiotics on farms by 40% over five years.
I look forward to an annual update on the whole long-term plan and to seeing some quick wins from this enormous investment of money, time and effort.

Baroness Wheeler: My Lords, I, too, congratulate my noble friend on securing this debate and on his excellent speech. There is much to commend and welcome in the NHS Long Term Plan. However, the key questions on how it is to be delivered in the light of the realities of the huge injection of cash the NHS needs on top of what has been pledged by the Government, how integrated care is to be achieved without addressing the funding crisis in social care and, without any indication in the plan, how the chronic shortage of staff in key professions is to be addressed all remain to be answered.
My contribution today is on specialised health services. These typically cover small patient populations, collectively treat hundreds of thousands of patients every year and cannot sensibly be planned, procured and provided at a local level. One in 17 people will be affected by a rare or complex condition at some point in their life. I declare an interest as a voluntary vice-chair of the cross-party Specialised Healthcare Alliance, which comprises charities and voluntary organisations, large and small, representing and campaigning for people with rare diseases and complex health conditions, and corporate supporters.
Many specialised services provide for people with rare genetic conditions, while anyone might need to call upon others, such as spinal injuries and serious burns. Under the Health and Social Care Act 2012, NHS England is the sole direct commissioner of all specialised services. It has a current annual budget of £16.6 billion of the NHS total spend. Before the Act, services were planned at either local or regional level, but in effect much of NHS England’s approach almost from the beginning of its existence has been to shift the balance back towards local decision-making. Indeed, the NHS Long Term Plan and last year’s supporting planning guidance represent the latest in a long line of attempts to get the balance right between national and local responsibility for planning specialised services. There are now to be planning boards across areas, with alternative collaborative arrangements in some circumstances.
Guidance so far is vague on structures, processes, procedures and timescales, so I have some key questions for the Minister and I ask her to write to me if she is unable to respond today. First, we are told that 70 services might benefit from local collaboration, with mental health, cancer and learning difficulties prioritised in the first instance. When will further details of the changes and processes for moving to the new structures and of the decisions on which services are to be provided locally be announced? What forms of alternative arrangements will be permitted?
My second question relates to the key issue of consultation with local services, patients, carers and representatives of patient organisations. NHS England seems to have learned from past experience of seeking to drive through changes without sufficient consultation and involvement. Can the Minister reassure the House  that the new specialised planning boards will embrace the provisions and spirit of patient involvement in the 2012 Act and include patients and public representatives, who will be meaningfully involved in decisions about the way their care will be delivered?
Finally, there must be clear and transparent accountability and oversight when service planning is delegated to local level. Can the Minister confirm that NHS England will retain overall accountability for all specialised services, and can he also confirm when formal accountability arrangements will be published? NHS England’s vision for specialised services presents important opportunities to improve patients’ experience of care. If it is to be realised, NHS England must take a transparent and collaborative approach to working with the public and patient organisations.

Lord Bird: My Lords, I am very grateful to the noble Lord, Lord Hunt, for this opportunity to talk about health.
If you really want to cheese off anybody from the health industry, when they start talking about not having enough doctors, nurses and assistants, you might choose to say, “Well, maybe the problem is that you’ve got too many patients”. I have tried that out in many places and have cheesed people off. However, when I tried it out on my GP, he said, “That’s very interesting. If I had 25% fewer people to handle, I could do a much better job than I am doing now”. The question of whether there might be too many patients rather than not enough doctors was raised by Matt Hancock, the Health Secretary, the other day when he said that we spend £97 billion on curing disease and £8 billion on prevention.
I first went to school as a child after the Second World War in 1951. Back then there was social medicine, with an enormous amount of National Health Service involvement in the lives of young working-class boys—even boys from the slums—in an attempt to prevent illness. We were given so much help that I think many of us have remained healthy. That is borne out by my reaching my 73rd birthday yesterday, which is an enormous surprise if you consider all the things that I have done to myself. It has not been the National Health Service that has helped me but I am still here, and I put it down to some of that early stuff back in the slums, when they got us running around, drinking milk and water, looking at our memberships, inspecting our hair and all sorts of wonderful things like that. However, I will not go into too much detail.
I am also interested in whether it is possible to look at the National Health Service as the very epicentre of our society, reinventing the concept of health over the next 20 years. I do not think that we should leave health to doctors or nurses; you should go to them only when something goes wrong. A very nice report by the Big Issue and CILIP on libraries and the reasons for supporting them proves that £27 million was saved for the National Health Service by running libraries and attacking the problems of loneliness.
I was on the train today and met a woman who was going to Addenbrooke’s Hospital for the last session of chemotherapy on her breasts. She went with a  fierceness, and I thought to myself, “God bless her”. It will increase her chance of surviving if her mental well-being is improved by a sense of happiness, hope and optimism, and that is what is created by areas outside the National Health Service. We have to reinvent the NHS so that it is the very epicentre of everything, with libraries, schools, universities and prisons all linked together.

Lord Holmes of Richmond: My Lords, I congratulate the noble Lord, Lord Hunt, on securing this debate. I also declare my interests as listed in the register.
In the time available, I will limit my comments to the potential of elements of the fourth industrial revolution, which could be deployed to assist the National Health Service and all healthcare. In fact, I will limit myself to two elements: artificial intelligence and distributed ledgers. Artificial intelligence has incredible potential to augment, not replace, our clinicians and so transform diagnosis and care. Let us consider the work that has been done at Moorfields, where artificial intelligence is being deployed to analyse hundreds of thousands of retina scans: something that it would be impossible for one person to do in a lifetime, never mind a career. Here artificial intelligence is not replacing but augmenting the consultants who are working in that area.
This goes beyond the business of healthcare into the business of the NHS itself. Let us consider the number of missed appointments, costing over £1 billion to the National Health Service. Artificial intelligence certainly has a role to play there. As we set out in the report of the Select Committee on Artificial Intelligence, published last April, were the United Kingdom to deploy ethical artificial intelligence effectively, we could be not just a world leader but a world beater. There can be no better place to do this, and no better illustration of it if we get it right in the NHS—and indeed across all healthcare.
I turn to distributed ledgers, which are often called blockchain but, in relation to how they are deployed, it is better to describe them as distributed ledgers. These are effectively immutable, anonymised, decentralised records with huge potential in healthcare for drug safety and security, care assurance and many other examples. But again, let us go beyond elements that impact directly on care. Currently, the NHS spends 25,000 doctor days on assuring the identity of people coming into the service. Assured ID is of course incredibly important, but there are many different ways of doing it. Imagine those 25,000 doctor days being deployed on patient care.
There is much disagreement around the potential of 4IR in health and many other areas but there is broad agreement on the critical and central importance of data. Data underpins all this; with NHS data comprising some 65 million patient records, it has extraordinary potential, although massive risks and issues remain to be understood, not least the almost singular lack of interoperability within the service. Practical problems also have to be considered against legal, cultural and ethical considerations.
Can my noble friend the Minister outline the Government’s plan to address probably the greatest epidemic in the NHS—that of data fragmentation? Data has always underpinned health innovation. Dr John Snow used it to isolate the cause of cholera and Florence Nightingale to revolutionise hospital hygiene. The NHS currently produces a proliferation of data but is all too often stymied in its ability to use and deploy it because the aforementioned fragmentation.
I am in no sense naive about the issues, risks and challenges of deploying these new technologies. To put it simply, we need to ensure that trust is fully and firmly at the centre of all our trusts.
Consider the immutability of all patient records—being able to have a single source of truth, your patient record, in your hand, alongside the trusted, immutable tracking of your timestamped record, including everyone who has accessed it and why. None of this is straight- forward. There is so much that the organisation must do to get to a position even to consider many of these technological possibilities, but they are possibilities. If the NHS is an oil tanker, it is an oil tanker that has to climb a mountain. That is not easy.
If we get this right, even partially, we will not just have a National Health Service that is a world leader in patient care. We will have a National Health Service that is a leader in the adoption and deployment of artificial intelligence and distributed ledgers for public good: a service fit for the future enabled by the 4IR. That is a possibility, not an inevitability.

Viscount Hanworth: My Lords, this debate has been rich in its detailed treatment of particular issues but I shall talk only in general terms. At its inception in 1948, the NHS was an expression of the egalitarian philosophy of the Labour Party. At that time, it had the support of many Conservative politicians, but gradually they changed their opinions. They began to favour a health service in which consumers could exercise their preferences in favour of a more personalised provision, if that is what they wished for and if they were able to afford it.
In 2009 several leading Conservatives who were to become members of David Cameron’s Cabinet put their names to a manifesto criticising the NHS. They were calling in effect for the NHS to be dismantled and replaced by a system based on health insurance in which private providers would play a major part. This worried their leader, who was conscious of the popularity of the NHS and of the damage to the Conservatives’ electoral prospects that might ensue if their adverse attitudes towards it were widely perceived. For that reason, he felt compelled to assert that the NHS would be safe in the hands of the Conservatives. Nevertheless, the covert plans to privatise parts of the NHS proceeded unabated. The Health and Social Care Act 2012 was the precursor to its intended privatisation.

Baroness Browning: I advise the noble Viscount from personal experience that David Cameron’s motivation was not political expediency. As I know only too well, he had every reason to be grateful to the NHS because of his son.

Viscount Hanworth: I thank the noble Baroness for that interjection. I do not think the two issues are mutually exclusive; I think there was a very strong consciousness on his part, which may be commendable, that the NHS was very popular in public opinion. Be that as it may, the covert plans nevertheless proceeded, and the Health and Social Care Act 2012 was indeed intended as a precursor to privatisation. The Act aimed to induce competition among the agencies of the NHS and appointed clinical commissioning groups to govern the provision of medical services. These were to be run partly by the general practitioners but they were also to be the point of access for private service providers. The intentions of the 2012 Act have not been fulfilled. This has been due in part to the reluctance of the private sector to pursue the opportunities that have been offered. However, years of neglect and inadequate financial provision have ensued, which have brought the NHS to its present state of crisis.
It is against that backdrop that the Government have commissioned the NHS Long Term Plan that we are discussing today. The report has been authored by health service professionals. It envisages some felicitous prospects and is written in an optimistic spirit. Surely the Government have calculated that such a report cannot fail to do them credit. It is bound to divert attention away from the current problems.
The report recognises some of the major issues facing the NHS. These include the present inadequate funding, the shortfall in staffing, the inequalities of its provision across the regions, the pressure from an ageing population and the demand for innovative and expensive treatments that cannot be afforded easily. The report is remarkably sanguine in what it proposes can be done with a minimal increase in funding. It argues that the prevention of health problems can forestall the need for medical cure. It proposes that the demand on hospitals’ resources can be limited by reducing the number of patients and the length of their residence.

Three minutes!

Viscount Hanworth: I am sorry, I am going to take a little more time because some of this was pre-empted.

No!

Viscount Hanworth: No? Okay.

Lord Rennard: My Lords, I refer to my interests in the register. As an officer of the APPG on Smoking and Health, I am delighted to see that support for smokers accessing NHS services to quit is a key feature of the long-term plan’s commitments on preventive healthcare. Smoking remains the leading cause of preventable, premature death in England, killing nearly 80,000 people a year and costing the NHS an estimated £2 billion.
I welcome the plan’s commitments to fund new support for smokers to quit when in hospital, for long-term users of specialist mental health and learning disability services, and for pregnant women and their partners. The noble Lord, Lord Ribeiro, has already referred to how measures have been seen to work effectively using the Ottawa model for smoking cessation.  Where this model is applied in Canada, smoking status is recorded on admission to hospital, with staff delivering brief advice and providing medication to all smokers. Smokers are then followed up both in hospital and post discharge to provide them with specialist behavioural support. Rates of quitting with this model have improved dramatically, and those in the programme were also 50% less likely to be readmitted to hospital. The plan states that this support will be in place across all hospitals by 2023-24. Like the noble Lord, Lord Ribeiro, I hope that the Minister may today give us an indication of when that rollout will begin and what funding will be made available for this programme over the life of the plan.
The plan’s commitments to support smokers who are long-term users of specialist mental health services, both in hospital and in the community, is also very welcome, but this will rely on upskilling a workforce that is already under great pressure. A survey by Action on Smoking and Health and the Mental Health and Smoking Partnership recently highlighted the very variable training and infrastructure in place to support smoke-free policies in different trusts. We need best practice in all of them.
I also welcome the explicit commitment in the plan for the option to switch to e-cigarettes, in line with guidance from Public Health England and the recommendations from the Science and Technology Select Committee last year. This option will be included in the support available to smokers in in-patient mental health services.
The plan also addresses the issue of smoking and pregnancy. Women who live with a smoker are six times more likely to smoke throughout their pregnancy. I hope the Minister may be able to tell us how additional support for partners, alongside that for pregnant women themselves, will be delivered and whether this will continue during postnatal appointments to maximise the chance for all children to grow up in a smoke-free home.
Successful implementation of the plan’s commitments to smoking cessation is clearly threatened as local authority public health budgets continue to be squeezed, reducing the funding for and availability of community stop-smoking services. I concur with the words of many others by saying simply that, without properly addressing the issues of social care and integration with local authorities, this plan will fail.

Lord Colwyn: My Lords, there are only eight speakers to go.
I must congratulate the noble Lord, Lord Hunt of Kings Heath, on his comments and explanation of the case for a fully funded, comprehensive and integrated health and care system. The noble Lord is a busy man: today he is talking about the long-term plan, tomorrow he is dealing with organ donations. I am interested as a retired dental surgeon and a fellow of the British Dental Association.
I would briefly like to turn the attention of the House to the issue of dentistry, which is notable by its total absence in the long-term plan. NHS dentistry  plays a key role in preventing oral health conditions and it is also a very good early indicator of a range of general health problems. But despite the Government’s insistence that prevention is at the core of their agenda, funding for NHS dentistry per head of population has fallen by 14% in nominal terms in the past five years.
Not a week goes by that we do not hear in the media a report about patients having to travel unreasonable distances to access an NHS dentist, or that they have had to perform some minor operation on the kitchen table. People unable to find a dentist show up at their GP surgery or A&E, neither of which can help them, further wasting precious NHS resources. The ambitions set out in the plan cannot work without significant improvements to the care of the health and social care workforce. Further, it is estimated that 1.8 million older people could have an urgent dental condition.
In the light of all this, I hope that my noble friend can offer some explanation why dentistry is barely mentioned in any long-term plan and what further plans the Government have to improve access to NHS dentistry.

Lord Brooke of Alverthorpe: My Lords, I express my gratitude to my noble friend Lord Hunt of Kings Heath for securing the debate. I thank the Government too for producing the long-term plan. I join others in applauding Professor Dame Sally Davies’s annual report for 2018 and the recommendations she has produced on how we might achieve better health in the UK by 2040. It is a particularly impressive document. She is one of the bravest of our public health servants.
I will not say anything on alcohol because that has been more than adequately covered by my friend, the noble Baroness, Lady Watkins of Tavistock, but I will focus mainly on obesity, which is identified in the plan as one of the major problems we face. I share my noble friend Lord Hunt’s disappointment that there is a paucity of public health initiatives in the plan. I support the views expressed by the noble Baroness, Lady Walmsley, and my noble friend Lord Turnberg on the importance of public health co-ordination and campaigning on obesity, which was also indirectly, in general terms, supported by the noble Lord, Lord Bird, who talked about how we need to raise our sights on where we are trying to go.
I have asked this question previously to the noble Lord, Lord O’Shaughnessy: where is the overarching co-ordinated national campaign against obesity? If it is truly the crisis that everyone keeps saying it is, why do we not have one? This morning, Public Health England reminded me of a whole variety of different initiatives it is running, but when I go to my GP and look at the noticeboard announcements, I see notices about smoking, drugs and alcohol, and services for babies, mothers and older patients. Obesity gets barely a mention, yet it is seen as one of the crises facing us. We must return to the topic of the amount of attention given to it centrally.
Last week, we had a very good debate on the inadequacy of local authority funding led by the noble Lord, Lord Scriven. Its focus was again primarily on social care, but there was little mention of the very  important responsibilities that now fall to local authorities regarding public health and public health campaigning. That again has been cut because of shortages of money at local authority level. I wrote to the Secretary of State when he took office pleading that he should give this a higher priority. I have had no reply, but maybe the Minister might follow this up to see whether his deliberations continue, and whether he will now respond positively and say that he is prepared to embrace this.
We really have to get a co-ordinated national campaign running, particularly for children. The plan focuses on people with diabetes and people with a BMI of 30-plus, but that excludes thousands of people who are obese and most of the children—there is nothing in it about children.
I tap my watch and see that I have come to the end of my remarks. Plenty of work can be done that does not necessarily cost money. We need to look at how we can engage children with programmes and games that will captivate them and turn their attention to their health. We can also look at cheap activities such as yoga that will help people find a way to look at their health and improve their positive outlook on life. There is much to be done. Is the Minister prepared to embrace some of these suggestions? We could then look forward to seeing a chapter 3 for the child obesity programme. When will it come?

Lord Stirrup: My Lords, I refer the House to my interests in the register and to the fact that I have family connections with the NHS. In the three minutes allotted to us in this important debate I can really make only one point: that the NHS Long Term Plan contains many worthy initiatives and objectives, but delivering the improvements that it seeks will be an extraordinarily difficult task, especially as we have no overarching strategy for health within the UK. I say this because a strategy must bring together ends, ways and means in a balanced and coherent way. No one issue can be addressed without the others.
When we talk about a fully funded health service, for example, we come face to face with the fundamental problem confronting the NHS and all other health services around the world. How does one constrain cost in a system of open-ended demand and ever-increasing technological opportunity? Without such constraint, healthcare is in effect an unbounded system; we could end up spending 100% of our GDP on it and still not satisfy every demand. The only rational answer is to balance resources and tasks by controlling both, rather than just one of them. This of course means limiting the care that is provided. That already happens, but in an often random and unplanned way. So the question we should be asking ourselves is: what is the most equitable system of rationing?
Whatever system is chosen, it will sometimes lead to unfortunate and perhaps tragic cases which frequently become political causes célèbres, so if we are to decide on the fairest and most efficient system of healthcare rationing, it must be done on a cross-party basis. As long as healthcare is treated as a political football, effective solutions to this conundrum will continue to elude us.
Let me caution against the pursuit of apparently attractive but, in the long term, chimerical solutions. One of the most common is the cry for greater efficiency. The idea that this can be used to wish away the underlying financial dilemma is ill-considered at best and mendacious at worst.
Nor should we think that restructuring healthcare will make the problem any easier. Preventive measures to improve long-term health are important, but they are unlikely to moderate demand for NHS services. We will all, alas, continue to suffer physical, and perhaps mental, deterioration over time. The clinical causes of the deterioration may change, but they will still need to be treated or ameliorated. It therefore follows that improved public health programmes, while essential, will over time likely result in greater expenditure rather than less.
The NHS Long Term Plan covers many important areas and sets out some laudable ambitions. But unless we find a sustainable way of balancing ends, ways and means, we will still not have an effective healthcare strategy.

Baroness Massey of Darwen: My Lords, I thank my noble friend Lord Hunt for securing this important debate and for his well-known commitment to health services.
I was particular struck by one sentence among many in the Oral Statement earlier this month. It said:
“At the heart of the Plan is the principle that prevention is better than cure”.—[Official Report, 7/1/19; col. 2069.]
I agree, but I was disappointed to see that there was not so much emphasis on public health, community involvement, youth health or better cost analysis. Organisations which we know sent briefings and were generally supportive of the plan’s aims. One said that,
“some significant pieces of the jigsaw are … missing”.
Another said that the long-term plan is,
“defined as much by what it omitted as what it contained”.
I will identify some things as I see them. The British Association for Sexual Health and HIV expressed concerns about public health funding—which, of course, supports prevention. These services have been cut in recent years; around £700 million will be cut between 2014 and 2020.
I am also surprised to see no cost-effectiveness figures in the plan. Are they available elsewhere? It is surely important to weigh the potential cost savings from prevention versus treatment costs. The plan states that in April 2019 NHS England will introduce more accurate assessments of the need for community health and mental health services. Will this be done in real consultation with local groups to identify local, specific needs?
Moving on to young people, I thank the Association for Young People’s Health for its analysis. It is important to recognise that early intervention is not just about young children. Adolescence provides a second window, given the massive brain development and growing maturity in sexuality, relationships and reasoning among adolescents. Adolescent services are crucial to any health plan and are not sufficiently addressed in this one, yet they are key to general health.
Last week I was involved in a seminar with young people. One young woman said that we are experts by experience—how true. So are communities experts by experience, and they need to be listened to in order to formulate responses. Will the Government take note of the concerns expressed in this dynamic and wise debate—and, more importantly, will they keep the debate going so that we can all have a say in what is happening to this plan?

Baroness Redfern: My Lords, I thank the noble Lord, Lord Hunt, for bringing this important debate to the House, and welcome the plan. All the evidence tells us that the UK population is set to grow and age significantly over the next 10 years, with people over 65 increasing by 33% and over-85s almost doubling, against an increase of only 2% in working adults. On the basis of delivering this health prevention agenda against a growing population, in developing this plan and framework the Government and the NHS have worked closely with local authorities, patient organisations, NHS staff and the public so that everyone has the opportunity to contribute.
The shortage of trained staff needs to be resolved if the ambitions in this long term plan are to be achieved. I am pleased to hear today of the announcement of the biggest reform to GP practices in 15 years, to improve access and create 20,000 more staff for those practices. Supporting staff and boosting morale with rewards for career progression should help to retain our experienced, dedicated staff and help to grow our own.
Reducing and tackling waste with smarter working to improve productivity and efficiency is important. Prevention is the key to transformation—expanding screening and age range—as survival rates can be improved dramatically by earlier diagnosis and early multi-access to treatment. It is about empowering patients to become more effective in managing their own health and to take responsibility as part of their personal decision-making. This long-term plan is ambitious, aiming to transform services using up to date technology to provide many more online interventions for patients and so reduce up to a third of out-patient appointments.
With excellent sharing of data—precision diagnosis, the earliest interventions backed up by detailed costs of investment, covering genetic data around performance and outcomes—more capital investment will be required. For example, we need more MRI and CT scanners to improve survival rates. Data collection, handling, storage and sharing to achieve and facilitate IT skills technology, saves time and money, so I am pleased to see the Government wanting to invest £440 million in new technology and £75 million in electronic systems to unlock the full potential of biopharmaceutical, personalised medicines, genomics and the identification of applications for stem cells and the development of new drugs—but we need to be much quicker in decision-making on those appraisals.
I welcome the proposed increased investments in primary and community care, focusing on full integration of health and social care, moving out of hospital  settings and into the community to deliver more care in the home, as new technologies unleash the ability to deliver a high-quality service so that only patients triaged with more acute or specialised care are in hospital.
Finally, having seen the changes over the past 70 years, I look forward with optimism to the ambitious long-term plan that sets out to modernise the NHS for the next 20 years.

Baroness Jolly: My Lords, I draw attention to my interests as declared in the register. It is worth mentioning that the noble Baroness, Lady Browning, is the only Peer to have mentioned people with learning disability and autism. In 2015, following the Winterbourne View scandal, there came the Transforming Care programme. Can the Minister outline in a letter or, if there is time, at the end of the debate what progress has been made and whether local authorities received the budgets required to match the services they are delivering?
I thank the noble Lord, Lord Hunt, for calling this debate. The long-term plan is detailed and forward thinking, but without supported staff, sufficient resources and consideration of social care, it is difficult to see how the Government can achieve the comprehensive and integrated health system to which they aspire. The long-term plan is a positive step forward, but it is defined as much by what it omits as what it contains. Without a workforce strategy, the social care Green Paper and involvement of local authorities and not-for-profits, the plan is incomplete.
We have 100,000 vacancies in our health system. The 3.4% uplift in long-term funding for the NHS does not cover key areas of health spending, and uptake of innovation is patchy. By 2030, we could have a quarter of a million vacancies in our NHS, including in key areas such as nursing. We are already suffering from the loss of 5,000 mental health nurses since 2010 and a 50% drop in the number of district nurses in the same period. The number of health visitors is down by 4,000, which does not bode well for children’s services and a healthy early start. My key concern is that, while the long-term plan recognises the workforce crisis, there is no magic bullet. Without solving staffing problems, many of the goals in the plan will go unfulfilled.
The crisis is exacerbated partly because workforce planning in England has become increasingly fragmented and incomplete. Six years on from the introduction of the Health and Social Care Act, it remains unclear who is accountable for workforce strategy and investment. Can the Government confirm where the buck stops for workforce planning for nurses, doctors and care staff? What timeline can we expect for the release of the workforce plan, which will provide more detail on strategy? Is the March date given to the noble Baroness, Lady Harding, realistic? A “quick and dirty” piece of work will give us a picture of what is happening, but it is the resulting timelines for all the strands of this work that will shape the workforce of the future.
I hope that we will see health and social care considered together in the workforce plan, as many other noble Lords have said. Integrating health and  social care would, for instance, strengthen our ability to support individuals with multi-morbidities, an area that was relatively neglected in the plan.
The rollout of the “enhanced health in care homes” model, which strives for co-ordination and co-operation between care homes and the NHS, is an encouraging commitment in the plan which recognises barriers to good health and attempts to overcome silos. Overcoming silos can also mean broadening skill sets.
One headline in the plan is the greater focus on training “generalist” doctors. This is a good idea; we should not neglect encouraging broad skill sets at all levels of health and social care. Can the Minister expand on this proposal for generalist doctors? It would require reinvestment in training. In 2006-07, the training and education budget was 5% of the NHS’s total budget, but that has now fallen to 3%. It would cost £2 billion to put the budget back to 5%, but the returns may be far greater, so for the Chancellor it could be a good deal.
Retention of staff is a problem. It is such a waste if trained staff leave for a better-managed, better-paid role elsewhere. A start might be to look at rostering. Complaints about inflexible rosters from nurses, but also of late from junior doctors, make for a culture of stress, leading to staff opting for agency or bank work, where choice or control is possible for the individual but not, of course, for the hospital. Some hospitals do this successfully; others need to copy what is done.
To retain experienced staff, could the Government also encourage employers to pay a living wage to social care workers? This could form part of the social care Green Paper when it arrives. Currently, many in our community are being served by staff who are overstretched and underpaid. Social care staff in hospitals, care homes and the community are the glue that keeps the system together, that prevents admissions from the community, and that speeds patients home.
In the past, key medical innovations tended to be within the realms of big pharma. Now innovation appears in the form of med-tech, robotic surgery and other surgical improvements such as delivering TAVI heart valves through the groin. Under a local anaesthetic, this achieves today what before required open heart surgery, with all the risks that entailed. This is not only a surgical improvement; patient stays are hugely reduced and outcomes often immediate.
In the long-term plan, there is a laudable focus on digital health to bolster access to services, which, if carefully implemented, may increase patient satisfaction and help to minimise wasted resources. Some surgeries do this better than others. I had to cancel a doctor’s appointment to take part in a debate tomorrow—I sent a text; they confirmed with a reminder text; all I needed to do was type “absent”, and they cancelled the appointment. Innovation in staff rostering can improve staff and ward morale and allow a better work/life balance.
I have a couple of questions for the Minister, which I am happy to wait for. What support are the Government giving to innovators and early adopters of technology designed for use in operations and other clinical interventions? What changes need to be made to commissioning to accommodate and support innovation?
Looking at the speakers’ list, it is no surprise that this has been an interesting and well-informed debate—it is always going to be the way. There is much and varied experience in your Lordships’ House, and I thank the noble Lord, Lord Hunt of Kings Heath, for tabling the debate.

Baroness Thornton: My Lords, I start by congratulating my noble friend Lord Hunt on initiating this important debate. I also congratulate noble Lords on the discipline they have mostly shown in this debate, and on the spread and depth of the views that they have expressed.
I will not summarise the contents of the 10-year plan, because my noble friend did that extremely well in his opening remarks. Noble Lords have covered a great deal of ground in the last two hours, and presented the Minister with a veritable cornucopia of questions to answer—some of which I suspect she may pass over to the new Minister when she arrives here on Monday.
I intend to focus on implementation and finance—chapters 6 and 7—and also make some remarks on digital transformation. There is no doubt that this is an ambitious plan, and it needs to be ambitious. The key question is: how will it be delivered? As noble Lords have said, there are dozens of aspirations in the plan; so far it seems to have avoided the previous pitfalls of promising unrealistic productivity gains and savings from reducing demand.
I was struck by the pertinence of the remarks made by the noble Lord, Lord Kakkar, when we discussed the launch of this on 7 January. He said:
“How are Her Majesty’s Government going to go about developing the metrics to determine how success should be measured? How will they go about providing a baseline picture of the current situation in different parts of the National Health Service so that the purpose and ambition of this plan can be properly measured? Which part of the NHS is going to be responsible for measurement and implementation: NHS England, NHS Improvement or, indeed, the Department of Health and Social Care?”.—[Official Report, 7/1/19; col. 2076.]
Those remarks were echoed by my noble friends Lady Donaghy and Lady Massey. I could not have put it better myself, so I did not try. I hope the noble Lord might forgive me for repeating his questions, because I do not think they were adequately answered on 7 January. They will run through the course of the discussions we will have over the coming period.
These questions are important because the plan fails to set out what success looks like for the patients, carers and staff. It does not set out how worthy aims are to be achieved, and there is no coherent approach to the management of the necessary changes. My noble friend Lord Brooke’s description of obesity perfectly illustrates that.
On implementation, my question here also concerns the somewhat Delphic reference to legislation in the plan. Is this the rollback of the hideously complex and expensive competitive frameworks, with the accompanying bureaucracy, that exist at the moment, referred to by my noble friend Lord Hanworth? Is the Minister able to enlighten the House further as to when and to what purpose this legislation will be scheduled? Indeed, do the ICSs need primary legislation, and what will be the role of local government in them?
On finances, my noble friend Lord Hunt described the finances as “courageous”; I might add that they are rather heroic. As noble Lords will be aware, last summer the Prime Minister announced £20.5 billion extra funding for the NHS by 2023-24. While this is generous compared with other public services, all informed opinion suggests that it is barely enough to keep pace with growing demand for care. As Dr Anita Charlesworth from the Health Foundation says in her excellent analysis, which I recommend to Members of the House:
“This means trade-offs are inevitable, and these must be spelled out clearly so the public know what they can expect from the NHS”.
In a way, that was at the heart of what my noble friends Lady Wheeler and Lady Gale said about specific conditions.
Can the Minister explain how this settlement will do more than keep the show on the road? How much will be available for investment in the aspirations contained in the 10-year plan? Today we learn that a new five-year contract will provide billions in funding for GPs and primary care networks; this is excellent news and a good proposal, but is this money coming from existing budgets, from the £20 billion, or is it new money?
There is no sign of an end to the sustained cuts to public health, capital spending and workforce training budgets. We know that NHS hospitals are in deficit and that the waiting times targets for accident and emergency and planned operations have not been met for three years. There is a crisis in social care that we have to find the funding for, as well as investment for mental health, so there is an enormous amount to do. As my noble friend Lady Pitkeathley asked, how will we fund recognition of the work of carers, for example? The Minister needs to tell us how all these things will be funded.
The chapters concerning science, digital and data are important aspirations: the adoption of personalised medicine, the adoption of genomics to drive diagnosis and the selection of care, the development of a workforce that is able to apply innovation and genomic medicine to the routine care of patients, and the adoption of a digital strategy for patients and healthcare professionals to improve clinical outcomes. I welcome these; they are forward-looking, and in many ways they are the only way forward for a modern health service. The noble Lord, Lord O’Shaughnessy, has been driving this agenda in government, and the work of people such as my noble friends Lord Darzi and Lord Winston and the noble Lord, Lord Kakkar, is very exciting; building international partnerships will take this agenda forward, although I hope that Brexit does not cast a shadow and a cloud over this. I ask the Minister: what is the timetable for the digital rollout? As everyone is aware, the NHS has form on being challenged in delivering these ambitious digital programmes. How will NHS England ensure that it has the capacity to deliver this change, which will be so important?
I would like to raise one issue which we have discussed in your Lordships’ House in the past: the use of NHS data and how to harness the value of healthcare data from government. While the Government say  they are committed to maximising the value of healthcare data, there is a growing consensus that a national approach is needed if the UK is not to reach a tipping point beyond which the value of NHS data assets depreciates relative to those invested in and made available on mutually beneficial terms elsewhere in the world—specifically, the complexities of data holdings across would-be integrated care systems. In addition, private sector providers are liable to render it near impossible for local organisations not to undermine, inhibit or impact the ability of the NHS to maximise the value and use of NHS data. The noble Lord, Lord Freyberg, is right to pursue the idea of the creation of a framework, which he called a sovereign health fund, to ensure that the NHS benefits from this.
This is important because the amounts of money involved are absolutely enormous. For example, the noble Lord, Lord Drayson, says that, for publicly listed fund companies, knowledge assets account for 50% to 80% of the total value. The value held by the UK Government for NHS data could be as high as £1 trillion. That could be invested in our NHS, if we can get the infrastructure right. What is the Minister’s opinion of that? Such figures would make all the difference to our NHS, and I imagine they are very attractive to companies such as Google. It is important that the Government deal with that.
I close by thanking my noble friend Lord Hunt, other noble Lords and the many organisations which sent briefing materials—too many to mention. They tell me that we are at the beginning of a great discussion, and I suggest that noble Lords file debates about the different parts of the 10-year plan that so that we can have longer than three minutes on all the important issues that they raise. That will be a good way to welcome our new Minister to the House.

Baroness Manzoor: My Lords, I too thank the noble Lord, Lord Hunt, for raising this important debate and presenting the issues in his usual authoritative and well-informed way. I also thank all noble Lords for their valuable contributions; it has been a very well-informed debate and I am certainly learning fast.
I say humbly what a credit it has been to the House to hear about the NHS in a positive light. I understand that there are challenges and noble Lords have put many questions to me. Nevertheless, the support around the House for the NHS plan is very welcome.
It is fair to say that 2018 has been a remarkable year for the health service. As many noble Lords will appreciate, celebrating a 70th birthday is a time to reflect on what has been achieved and to look ahead with hope and optimism. As my noble friends Lord O’Shaughnessy and Lady Cumberlege said, the NHS has begun 2019 by publishing an unprecedented long-term plan for the next decade. The plan sets out a compelling vision of how the health service will provide a safer, more personalised service and more integrated care using technology and new ways of working to deliver more services in one’s own home or community.
To reassure my noble friend Lady Neville-Rolfe, the noble Lord, Lord Scriven, the noble Baronesses, Lady Donaghy and Lady Watkins of Tavistock, and the  noble and gallant Lord, Lord Stirrup, I can say that the long-term plan is fully costed and has been developed within the spending settlement agreed with the NHS: an extra £33 billion in cash to reach a total of £148.5 billion in 2023-24. This is the equivalent of £20.5 billion extra in real terms. This increased spending, together with stretching but achievable ambition on efficiency, should ensure that the NHS will continue to deliver the world-class service we all want.
First, I recognise the importance of improving patient experience, safety and flow through hospitals. I agree with the right reverend Prelate the Bishop of Carlisle that spiritual care plays an important part in health outcomes. As the noble Lord, Lord Hunt, will be aware, NHS England is undertaking a clinical review of standards, considering the appropriateness of operational standards for physical and mental health relating to planned, unplanned, urgent or emergency care.
In 2018-19, the Government provided the NHS with an additional £1.6 billion to support and improve A&E and elective care performance. The NHS will use this investment to treat 250,000 more patients in A&E in 2018-19 and improve performance, with the four-hour standard to be achieved within 2019.
Many noble Lords, including the noble Baronesses, Lady Gale, Lady Wheeler and Lady Tyler of Enfield, and the noble Lord, Lord Hunt, inquired about the adult social care Green Paper. The Department of Health and Social Care is in the final stages of preparing it, and it will be published at the earliest opportunity. As noble Lords are aware, building a sustainable care and support system will require big decisions, and the upcoming Green Paper will place on record the extraordinarily difficult choices that we as a legislature and, more broadly, we as a country, must confront.
I understand the concerns raised by my noble friend Lord Hunt—he is a friend—regarding integration. As he indicated, the Green Paper will build on the proposals on integration in the long-term plan, which are the deepest and most sophisticated ever proposed by the NHS. We will invest in models of care that strengthen links between primary care networks and local care homes, as my noble friend Lord O’Shaughnessy laid out so clearly, alongside innovation. By 2021, every part of the country will be covered by integrated care systems, which will bring together local organisations, including local authorities, to redesign care and improve population health. I say to the noble Baronesses, Lady Massey of Darwen and Lady Pitkeathley, that this marks a significant change in how NHS organisations collaborate with one another and will support the health and care system to deliver a step change in how patient care is planned and delivered.
My noble friend Lord O’Shaughnessy raised the issue of primary legislation. He will be aware that the Government will consider updating legislation only where there is clear evidence that doing so would improve services for patients.
As noble Lords have noted, the spending review will have a profound impact on the prevention agenda. It will contain details of the local government funding settlement and the public health grant. As has been noted across the House, there is no time to waste in pushing forward this agenda. I say to the noble Lord,  Lord Bird, that this is why prevention is a focus throughout the long-term plan. We will keep people healthy and out of hospital by focusing on the prevention of ill health and boosting services closer to home.
To address comments made by the noble Lords, Lord Rennard, Lord Turnberg and Lord Brooke of Alverthorpe, and the noble Baroness, Lady Walmsley, there is a push to improve upstream prevention of avoidable illness and its complications, such as offering NHS-funded tobacco treatment services and specialist weight management services to those with hypertension and a BMI over 30. A number of noble Lords mentioned smoking. The plan commits to offering all smokers admitted to hospital NHS-funded tobacco treatment services by 2023-24. I believe that this issue was raised by the noble Lords, Lord Rennard and Lord Turnberg, and my noble friend Lord Ribeiro.
I also note that my noble friend Lord Chadlington raised the issue of gambling and the noble Lord, Lord Brooke, mentioned gaming. We must look at those important issues in relation to health and health services. As a result of the long-term plan, within 10 years, 55,000 more people each year will survive cancer for at least five years and up to 150,000 heart attacks, strokes and dementia cases will have been prevented. In addition, we will take coherent cross-government action where required. This was demonstrated by the recent joint Defra and DHSC clean air strategy, as well as by the Government’s new world-leading plan on antimicrobial resistance, as noted by my noble friend Lady Neville-Rolfe.
The upcoming prevention Green Paper will be a major milestone in the prevention agenda this year. Our approach will also be underpinned by a focus on the reduction of health inequalities, both because it is unequivocally the right thing to do and because the potential health gains, especially in our most vulnerable communities, are significant. That was noted by the noble Baronesses, Lady Donaghy, Lady Tyler and Lady Massey. Of course, that focus will be very important.
I turn now to the plan’s commitment to improve access to primary and community healthcare services, with spending on these services increasing by £4.5 billion in five years’ time. This will allow all parts of the country to see an increase in both the capacity and the responsiveness of community and intermediate care services. As my noble friend Lady Redfern and the noble Baroness, Lady Thornton, noted, today NHS England and the British Medical Association launched the new primary care contract for GPs. The new contract framework marks some of the biggest general practice contract changes for over a decade and will be essential to delivering the ambitions set out in the NHS Long Term Plan through strong general practice services. It also includes funding for around 20,000 more health professionals in primary care networks by 2023-24. Expanding community-based multidisciplinary teams means thousands more clinical staff working in primary care and bigger teams of staff providing a wide range of care options for patients and freeing up time for GPs to focus on those with more complex needs.
My noble friend Lord Colwyn raised the important issue of dental care and NHS dentists. He is right to say that workforce planning is important in this key area.  In addition, by 2023-24, every patient in England will be able to access a digital GP offer, improving access and convenience in primary care for all. Social care prescribing where appropriate, as mentioned by the noble Baroness, Lady Pitkeathley, will play a role in this.
That brings me to the important point on the safety of patient data. There are safeguards in place for this type of data, including legislation, scrutiny standards and toolkits, independent advisory bodies and a national data opt-out to ensure that data is used across the health and care system in a safe, secure and legal way. However, in response to the noble Lord, Lord Hunt, I recognise that we still have some way to go.
While I have already noted the importance of preventive care as a priority for this Government and the NHS, the plan also addresses important clinical areas and long-term conditions. Noble Lords have rightly identified that improving the early diagnosis of cancer is a priority. The new package of measures in the long-term plan include investment to support better screening services, provide new investment in state-of-the-art technology to transform the process of diagnosis and boost research and innovation. To that degree, the noble Baroness, Lady Thornton, is absolutely right.
As the noble Baronesses, Lady Masham of Ilton, Lady Gale and Lady Wheeler, identified, it is equally important that those with rare and complex conditions should receive the best support and treatment. I welcome the fact that over the next 10 years, the long-term plan will give patients better access to specialised services and offer more precise treatments. The department will continue to work with the NHS to ensure that we provide the very best service so that patient outcomes and quality of life are improved. As the NHS implements the plan, specialised services will remain a priority. That is why, every year, we invest more than £16 million in treating specialist conditions, as noted by the noble Baroness, Lady Wheeler.
I turn now to the provision of mental health services. Yesterday we had an excellent debate on this subject led by the noble Baroness, Lady Tyler of Enfield. As we know, more work days are lost to mental ill health in the form of anxiety, depression and stress than any other condition, so we have to get this right. I can reassure noble Lords that under the NHS Long Term Plan there will be a comprehensive expansion of mental health services. The plan renews the commitment to grow and invest in mental health services faster than the NHS budget overall for each of the next five years, with an additional £2.3 billion in real terms by 2023-24. This will provide a further 380,000 adults with access to psychological therapies and 345,000 more children will be able to access greater support. Crisis care will be expanded with a 24/7 community-based mental health crisis response for adults. We will ensure that that is available across England by 2020-21.
The NHS will test and roll out new waiting times to ensure rapid access to mental health services in the community over the next decade. We will reduce the number of people with learning disabilities or autism who are in-patients in mental health hospitals. It is absolutely right that we do so, and I totally support the comments made by my noble friend Lady Browning and the noble Baroness, Lady Jolly.
Specific waiting times for emergency mental health services will also take effect from 2020 for the first time, and will be set to align with the equivalent targets for emergency physical health services. This is the first time that this has happened and it is absolutely right.
I welcome the support of the noble Baroness, Lady Pitkeathley, for the NHS plan in relation to carers. Carers’ needs and views are important, and we acknowledge this.
The noble Lord, Lord Low of Dalston, raised the issue of eye care and the APPG report. I will write to the noble Lord to address this, because I am not familiar with the APPG report.
A large number of noble Lords—including my noble friend Lord Ribeiro, the noble Lords, Lord Turnberg and Lord Hunt, and the noble Baronesses, Lady Watkins and Lady Jolly—quite rightly raised workforce issues, and I want to acknowledge, as I am sure they do, the importance of our NHS workforce and all who work in it. We recognise that good leaders and leadership are essential to the provision of high-quality, sustainable services across the NHS. As part of the long-term plan, a group has been established to focus on how best to improve leadership culture and practice, talent management, leadership development and clinical leadership across the whole NHS. This work will inform the workforce implementation plan that the noble Baroness, Lady Harding, has been commissioned to produce, working closely with Sir David Behan. Initial recommendations will be presented to the department in spring 2019 and a final workforce implementation plan will follow later in the year, taking into account the outcomes of the spending review. We will go further not only to secure staff but to support the NHS in delivering its mission to become a world-class employer and to deliver the workforce the NHS needs.
A number of noble Lords raised the important issue of how we will ensure we have enough nurses, including Parkinson’s nurses. We are already taking steps, including increasing nurse training places by 25%—that is 5,000 additional training places from 2019-20. The NHS Improvement-led workforce group will agree action to improve the supply of nurses over the course of the long-term plan.
My noble friend Lord Ribeiro and the noble Lords, Lord Turnberg and Lord Rogan, will know that we have already made commitments through the next spending review period—for example, as my noble friend Lord Ribeiro said, medical training places—that acknowledge the importance of workforce training to underpin effective long-term NHS planning. At the forthcoming spending review, we will consider proposals from the NHS for a multi-year funding plan for clinical training places, based on workforce requirements in the NHS plan.
Health services are of course a devolved matter in Northern Ireland, but I will certainly convey the concerns raised by the noble Lord, Lord Rogan.
A number of noble Lords—my noble friends Lord Holmes of Richmond, Lady Neville-Rolfe and Lady Redfern, the noble Lords, Lord Hunt and Lord Scriven, and the noble Baroness, Lady Thornton—raised  technology and artificial intelligence. As the Secretary of State has made clear in his vision for the future of healthcare, digital services and IT systems will need to comply with a modern technology architecture and meet a clear set of open standards so that they can talk to each other.
There have been many questions and I will shortly run out of time. However, I will write to noble Lords about the key themes that have come out in the debate and place a copy of my letter in the Library.
I did not get round to talking about technology and artificial intelligence. The Secretary of State considers this to be an important area, and I hear the concerns raised by the noble Lord, Lord Hunt.
I again place on record my thanks and appreciation for the quality and range of contributions from across the House. There is clearly much more to discuss and debate. The incoming Minister will have the opportunity to discuss these issues in greater depth with the House, including the many areas covered by the noble Baroness, Lady Thornton. We will keep the debate going.

Lord Hunt of Kings Heath: My Lords, I have a minute to wind up. It has been an excellent debate containing five key messages. First, integration of health and social care will not happen unless the Government in Whitehall integrate their strategy on policy finance and workforce.
Secondly, this House definitely supports the priorities in the NHS 10-year plan but it must not be at the expense of core services such as oral health or eye   care. I hope the noble Baroness will meet with me and the noble Lord, Lord Low, to discuss the issues he raised about ophthalmology services.
Thirdly, the Government need to be brave on public health. It is clear from speeches made today in this House that huge support will be given to tough fiscal measures.
Fourthly, this is an English plan but its challenges relate also to Scotland, Wales and Northern Ireland. I hope that the noble Lord, Lord Rogan, will be heard, because the Northern Ireland health service is going through a tough time.
Finally, carers will be asked to do even more in the future, and they must have recognition and support.
This is a good plan but the agenda is tough. I hope the Government will listen to what has been said today. I beg to move.
Motion agreed.

Crime (Overseas Production Orders) Bill [HL]
 - Returned from the Commons

The Bill was returned from the Commons agreed to with amendments. It was ordered that the Commons amendments be printed.
House adjourned at 5.41 pm.